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Multicenter Study
. 2024 Sep 3;79(9):2132-2141.
doi: 10.1093/jac/dkae157.

Risk factors for bloodstream infections due to carbapenem-resistant Enterobacterales: a nested case-control-control study

Hongyu Zhou  1   2 , Niccolò Buetti  1   3 , Salvador Pérez-Galera  4   5 , Jose Bravo-Ferrer  5   6 , Belén Gutiérrez-Gutiérrez  5   6   7 , María Paniagua-García  5   7   8 , Jan Feifel  9 , Julien Sauser  1 , Tomi Kostyanev  10   11 , Rafael Canton  7   12 , Lionel K Tan  13 , Dimitris Basoulis  14 , Vicente Pintado  7   15 , Emmanuel Roilides  16 , Gorana Dragovac  17 , Julian Torre-Cisneros  7   18 , Deana Mediç  17 , Murat Akova  19 , Herman Goossens  10 , Marc Bonten  20 , Stephan Harbarth  1 , Jesus Rodriguez-Baño  5   6   7 , Marlieke E A De Kraker  1 ; COMBACTE- EURECA project team
Collaborators, Affiliations
Multicenter Study

Risk factors for bloodstream infections due to carbapenem-resistant Enterobacterales: a nested case-control-control study

Hongyu Zhou et al. J Antimicrob Chemother. .

Abstract

Background: Carbapenem-resistant Enterobacterales (CRE) bloodstream infections (BSIs) are a major threat to patients. To date, data on risk factors have been limited, with low internal and external validity. In this multicentre study, risk factors for CRE BSI were determined by comparison with two control groups: patients with carbapenem-susceptible Enterobacterales (CSE) BSI, and patients without Enterobacterales infection (uninfected patients).

Methods: A multicentre, case-control-control study was nested in a European prospective cohort study on CRE (EURECA). CRE BSI:CSE BSI matching was 1:1, CRE BSI:Uninfected patients matching was 1:3, based on hospital, ward and length of stay. Conditional logistic regression was applied.

Results: From March 2016 to November 2018, 73 CRE BSIs, 73 CSE BSIs and 219 uninfected patients were included from 18 European hospitals. For CRE versus CSE BSI, previous CRE colonization/infection [incidence rate ratio (IRR) 7.32; 95% CI 1.65-32.38) increased the risk. For CRE versus uninfected controls, independent risk factors included: older age (IRR 1.03; 95% CI 1.01-1.06), patient referral (long-term care facility: IRR 7.19; 95% CI 1.51-34.24; acute care hospital: IRR 5.26; 95% CI 1.61-17.11), previous colonization/infection with other MDR organisms (MDROs) (IRR 9.71; 95% CI 2.33-40.56), haemodialysis (IRR 8.59; 95% CI 1.82-40.53), invasive procedures (IRR 5.66; 95% CI 2.11-15.16), and β-lactam/β-lactamase inhibitor combinations (IRR 3.92; 95% CI 1.68-9.13) or third/fourth generation cephalosporin (IRR 2.75; 95% CI 1.06-7.11) exposure within 3 months before enrolment.

Conclusions: Evidence of previous CRE colonization/infection was a major risk factor for carbapenem resistance among Enterobacterales BSI. Compared with uninfected patients, evidence of previous MDRO colonization/infection and healthcare exposure were important risk factors for CRE BSI. Targeted screening, infection prevention and antimicrobial stewardship should focus on these high-risk patients.

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Figures

Figure 1.
Figure 1.
Flow chart for patient enrolment in EURECA between March 2016 and November 2018, including the final selection for the nested case-control-control study focusing on risk factors for carbapenem-resistant Enterobacterales (CRE) bloodstream infections (BSIs). CSE, carbapenem-susceptible Enterobacterales.
See this image and copyright information in PMC

References

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