Incidence Rates and Predictors of Co-detection of Clostridioides difficile and Carbapenem-Resistant Enterobacteriaceae and impact on mortality in Metropolitan Atlanta 2011-2015. Público

Woodworth, Michael (Spring 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/nc580m65k?locale=pt-BR
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Abstract

 

Background

Carbapenem-resistant Enterobacteriaceae (CRE) and Clostridioides difficile colonize the gut and share risk factors for transmission. However, data are limited on predictors for co-detection of these two urgent public health threats in individual patients and their impact on outcome.

Methods

The Georgia Emerging Infections Program performs active population and laboratory surveillance for C. difficile associated disease (CDAD) and CRE in the 8-county metropolitan Atlanta area. CDAD and CRE surveillance datasets from 8/2011 to 12/2015 were merged. Individuals with incident cases found in both datasets were defined as having co-detection. Patient-level covariates significant in bivariable analysis were eligible for inclusion in a multinomial logistic regression comparing CRE mono-detection and CRE/CDAD co-detection to CDAD mono-detection. Kaplan-Meier methods were used to estimate 90-day mortality from time of detection and compared with log-rank tests. Population-level death data were obtained by matching EIP datasets with state vital records death data.

Results

There were 757 incident CRE cases in 566 patients, 32,757 incident CDAD cases in 23,097 patients, and 211 incident CRE/CDAD co-detection cases in 128 patients. In co-detection cases, the median time between detections was 90.0 days (IQR 22-267 days). Both residence in long-term acute care hospitals or long-term care facilities (OR 1.94, 95% CI 1.06-3.57), and Charlson comorbidity index (CCI; OR 1.48, 95% CI 1.37-1.61) were associated with co-detection. Controlling for CCI, black vs not-black race was associated with co-detection (4.37, CI 2.06-9.26). 90-day mortality for patients with CRE/CDI co-detection (32.0%) and CRE mono-detection (29.3%) were worse than for CDI mono-detection (10.8%), p <0.0001.

Conclusions

Black race, residence in long-term care, and higher CCI are associated with CRE/CDAD co- detection, which has worse 90-day mortality than CDAD and similar mortality to CRE mono- detection. Identification of patients with CRE and C. difficile co-detection could inform infection prevention strategies, and direct therapeutic interventions such as fecal transplantation. 

Table of Contents

 

Introduction ............................................................................................. 1

Background ..............................................................................................4

Methods ................................................................................................. 10

Results .................................................................................................... 18

Discussion .............................................................................................. 22

References............................................................................................... 29

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