Christopher Bogan1, Keith S Kaye1, Teena Chopra1, Kayoko Hayakawa1, Jason M Pogue2, Paul R Lephart3, Suchitha Bheemreddy1, Tsilia Lazarovitch4, Ronit Zaidenstein5, Federico Perez6, Robert A Bonomo7, Dror Marchaim8. 1. Department of Medicine, Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, MI. 2. Department of Pharmacy Services, Detroit Medical Center, Wayne State University, Detroit, MI. 3. Department of Clinical Microbiology, Detroit Medical Center, Wayne State University, Detroit, MI. 4. Department of Clinical Microbiology, Assaf Harofeh Medical Center, Zerifin, Israel. 5. Division of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel. 6. VISN 10 Geriatric Research, Education, and Clinical Centers (GRECC) at Veterans Affairs Medical Center, Cleveland, OH; Department of Medicine, Veterans Affairs Medical Center, Cleveland, OH. 7. VISN 10 Geriatric Research, Education, and Clinical Centers (GRECC) at Veterans Affairs Medical Center, Cleveland, OH; Department of Medicine, Veterans Affairs Medical Center, Cleveland, OH; Research Service, Veterans Affairs Medical Center, Cleveland, OH; Department of Pharmacology, Case Western Reserve University, Cleveland, OH; Department of Molecular Biology and Microbiology, Case Western Reserve University, Cleveland, OH. 8. Division of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: drormc@hotmail.com.
Abstract
BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) isolation is associated with poor outcomes. The matched cohort study design enables investigation of specific role of resistance in contributing to patients' outcomes. Patients with CRE were matched to 3 groups: (1) patients with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL), (2) patients with carbapenem-susceptible non-ESBL Enterobacteriaceae, and (3) uninfected controls. METHODS: Patients with CRE isolated at Detroit Medical Center (September 1, 2008, to August 31, 2009) were matched (1:1 ratio) to the 3 groups based on (1) bacteria type, (2) hospital/facility, (3) unit/clinic, (4) calendar year, and (5) time at risk (ie, from admission to culture). Multivariable logistic regression models for outcomes were constructed. RESULTS: Ninety-one patients with CRE were enrolled. CRE isolation was not an independent predictor for in-hospital mortality in any of the models (ie, vs uncolonized controls, vs ESBL, vs non-ESBL Enterobacteriaceae, and vs all 3 non-CRE groups combined), despite high significance of association in bivariate analyses. CRE isolation was independently associated with deterioration in functional status [odds ratio, 9; P = .002] and being discharged to a long-term care facility after being admitted to the hospital from home [odds ratio, 13.7; P < .001]. CONCLUSION: Underlying condition and comorbidities are the principal factors responsible for in-hospital mortality in CRE infections; however, in-hospital mortality is not independently correlated to the offending pathogen. In addition, we found that the pathogen contributes significantly to patients' degree of morbidity.
BACKGROUND:Carbapenem-resistant Enterobacteriaceae (CRE) isolation is associated with poor outcomes. The matched cohort study design enables investigation of specific role of resistance in contributing to patients' outcomes. Patients with CRE were matched to 3 groups: (1) patients with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL), (2) patients with carbapenem-susceptible non-ESBL Enterobacteriaceae, and (3) uninfected controls. METHODS:Patients with CRE isolated at Detroit Medical Center (September 1, 2008, to August 31, 2009) were matched (1:1 ratio) to the 3 groups based on (1) bacteria type, (2) hospital/facility, (3) unit/clinic, (4) calendar year, and (5) time at risk (ie, from admission to culture). Multivariable logistic regression models for outcomes were constructed. RESULTS: Ninety-one patients with CRE were enrolled. CRE isolation was not an independent predictor for in-hospital mortality in any of the models (ie, vs uncolonized controls, vs ESBL, vs non-ESBL Enterobacteriaceae, and vs all 3 non-CRE groups combined), despite high significance of association in bivariate analyses. CRE isolation was independently associated with deterioration in functional status [odds ratio, 9; P = .002] and being discharged to a long-term care facility after being admitted to the hospital from home [odds ratio, 13.7; P < .001]. CONCLUSION: Underlying condition and comorbidities are the principal factors responsible for in-hospital mortality in CRE infections; however, in-hospital mortality is not independently correlated to the offending pathogen. In addition, we found that the pathogen contributes significantly to patients' degree of morbidity.
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