Researchers found that patients colonized with carbapenem-producing carbapenem-resistant Enterobacteriaceae, or CP-CRE, who are subsequently infected with a different CP-CRE genotype are at a six times higher risk for dying.
“Carbapenem-resistant Enterobacteriaceae (CRE) are an emerging threat to health care communities globally, with an increase in health care burden and costs,” Wen Kai Chen, MBBS, MPH, of the department of epidemiology at Singapore General Hospital, and colleagues wrote. “Resistance to carbapenems is a result of two main mechanisms — firstly through the production of extended-spectrum beta-lactamases and/or Amp C cephalosporinase combined with altered membrane permeability or secondly through the production of carbapenemase.”
According to Chen and colleagues, patients infected with CP-CRE can introduce the bacteria to the hospital, causing contamination that could lead to subsequent spread to other patients and suggesting the possibility that patients with CP-CRE are infected with CP-CRE carrying another type of carbapenemase gene.
Using data collected from January 2012 through December 2016, Chen and colleagues conducted a small retrospective cohort study to determine whether CP-CRE carriers who developed infection with another genotype had a higher risk for mortality. They analyzed clinical isolates of CP-CRE in patients who had developed an infection during their hospital stay and compared CP-CRE carriers who developed clinical isolates of another genotype with those whose clinical isolates were the same genotype that they originally had.
In total, 73 CP-CRE carriers who developed infections were included. Findings showed that 15.4% (n = 10) of the carriers who developed an infection with isolates of the same CP-CRE genotype died after 14 days, whereas 62.5% (n = 5) of the patients who developed an infection with clinical isolates of a different genotype died after 14 days (adjusted RR = 6.36; 95% CI, 1.75-23.06).
“We present the first finding of an increased mortality risk to CP-CRE carriers, when
infected by another genotype of CP-CRE,” the authors concluded. “We hope that our study would spur more research into this premise. We are also mindful that greater debate is needed, revolving around the ethics involved in balancing the public health importance of reducing CP-CRE transmission, vs. the increased individual mortality risk of the cohorted patient.” – by Caitlyn Stulpin
Disclosures: The authors report no relevant financial disclosures.