Abstract
Prolonged carriage of carbapenemase-producing Enterobacteriaceae (CPE) constitutes a substantial epidemiologic threat. This study aimed to evaluate whether the types of carbapenemase and organism can affect the duration of carriage and to evaluate the clinical factors associated with prolonged carriage. We retrospectively reviewed data for patients admitted between May 2013 and August 2018 who were identified as CPE carriers. A total of 702 patients were identified; the major types of carbapenemase and organism were Oxacillinase (OXA)-48-like (n = 480, 68.4%) and Klebsiella pneumoniae (K. pneumoniae) (n = 584, 83.2%). The analyses of time to spontaneous decolonization using the Kaplan–Meier method showed that OXA-48-like and K. pneumoniae were significantly associated with prolonged carriage (log rank, p = 0.001 and p < 0.001). In multivariable logistic analysis to assess the risk factors for CPE prolonged carriage in the 188 patients with available follow-up culture data for 3 months, K. pneumoniae (adjusted odds ratio [aOR] 6.58; 95% confidence interval [CI], 1.05–41.27; p = 0.044), CPE positive clinical specimen (aOR 11.14; 95% CI, 4.73–26.25; p < 0.001), and concurrent Clostridioides difficile infection (CDI) (aOR 3.98, 95% CI 1.29–12.26; p = 0.016) were predictive of prolonged carriage. Our results suggest that CP-K. pneumoniae may have higher probability of prolonged carriage, while the effect of OXA-48-like CPE is inconclusive. Furthermore, patients with CP-K. pneumoniae who had positive clinical specimen or concurrent CDI can cause a vicious circle in prolonged carriage.
Highlights
We aimed to evaluate whether the types of carbapenemase and organism can affect the duration of carriage, and the clinical factors associated with prolonged carriage of carbapenemase-producing Enterobacteriaceae (CPE)
The probability of prolonged carriage estimated by the Kaplan-Meier method showed that OXA-48-like-producing CPE and K. pneumoniae were more likely to have prolonged carriage compared to NDM CPE and other species such as Enterobacter spp., respectively
The results indicate that clinical positive culture, concurrent Clostridioides difficile infection (CDI), and longer duration of hospitalization were predictive of prolonged carriage of CPE
Summary
The occurrence and spread of carbapenemase-producing Enterobacteriaceae (CPE) have been increasing worldwide [1]. Outbreaks of CPE attributed to plasmid-borne genetic elements have been reported mainly in the healthcare setting [2]. Transmission of CPE even in the community has already been demonstrated [3]. Colonization or carriage of carbapenem-resistant Enterobacteriaceae (CRE) may be followed by subsequent infections, which results in increased risk of death, especially in vulnerable patient groups [4,5]. Compared with non-CPE, CPE may play a more active role in outbreaks as an important 4.0/). The carriage state of CPE can lead to higher risks of subsequent infections associated with worse outcomes than that of non-CPE [8,9]
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