Predictors for Developing a Carbapenem-Resistant Enterobacteriaceae Invasive Infection from Bacteriuria Öffentlichkeit
Howard-Anderson, Jessica (Spring 2020)
Published
Abstract
Background
Infections with carbapenem-resistant Enterobacteriaceae (CRE) have limited treatment options and high mortality. Patients with CRE isolated only from urine (bacteriuria) have better outcomes than patients with CRE from a sterile site (invasive infection). This study describes the clinical epidemiology of CRE bacteriuria in metropolitan Atlanta and evaluates if urinary catheters increase the risk of “progression” from CRE bacteriuria to an invasive CRE infection.
Methods
We used active, laboratory- and population-based surveillance data from the Georgia Emerging Infections Program to identify patients with CRE bacteriuria in metropolitan Atlanta between 2012 - 2017. We calculated the annual incidence of CRE bacteriuria using census data and described the clinical characteristics of this cohort through chart review. We used univariable analyses to identify risk factors associated with progression to an invasive CRE infection within one year of CRE bacteriuria and multivariable logistic regression modeling to estimate the association between urinary catheters and progression. In an exploratory aim, we assessed the relatedness between urine and sterile site isolates from the same patient with pulsed-field gel electrophoresis and whole genome sequencing. Analyses were performed in SAS 9.4.
Results
We identified 464 patients with CRE bacteriuria, with a yearly incidence of 1.96 cases/100,000 population. Most patients had a urinary catheter (56%), and many resided in long term care facilities (49%), had a Charlson comorbidity index (CCI) >3 (37%), or had a decubitus ulcer (36%). 25 (6%) patients had progression. Risk factors for progression included black race, high CCI, presence of a urinary catheter, central venous catheter or another indwelling device, decubitus ulcer and having a culture obtained in an inpatient facility. In multivariable models, having a urinary catheter was associated with an increased the risk of progression (OR 4.1 95% CI 1.1 – 14.5). Most (6, 75%) patients with available isolates had highly related urine and sterile site CRE strains.
Conclusions
Patients with CRE bacteriuria are chronically ill and frequently have indwelling devices. Because urinary catheters may increase the risk of progression from CRE bacteriuria to an invasive infection, future interventions should target reducing inappropriate insertion and improving early appropriate removal of urinary catheters.
Table of Contents
Introduction 1 – 2
Background 3 – 6
Methods 7 – 14
Results 15 – 17
Discussion 18 – 23
References 24 – 28
Tables and Figures 29 – 38
Table 1 29
Table 2 30
Table 3 31
Table 4 32 – 33
Table 5 34
Table 6 35
Figure 1: Definitions of CRE 36
Figure 2: Annual Incidence 37
Rates of CRE Bacteriuria in
Metropolitan Atlanta, 2012-2107
Figure 3: Differences in Time to 38
Progression from Bacteriuria
to an Invasive Infection between
Patients with Different and Highly
Related CRE Strains
About this Master's Thesis
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