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Carbapenem-resistant Enterobacterales bacteriuria and subsequent bacteremia: A population-based study

Published online by Cambridge University Press:  10 December 2020

Jessica R. Howard-Anderson Open the ORCID record for Jessica R. Howard-Anderson [Opens in a new window] ,
Chris W. Bower ,
Gillian Smith ,
Mary Elizabeth Sexton ,
Monica M. Farley ,
Sarah W. Satola  and
Jesse T. Jacob
Jessica R. Howard-Anderson*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Georgia Emerging Infections Program, Atlanta, Georgia
Chris W. Bower
Affiliation:
Georgia Emerging Infections Program, Atlanta, Georgia Atlanta Veterans’ Affairs Medical Center, Decatur, Georgia Foundation for Atlanta Veterans’ Education & Research, Decatur, Georgia
Gillian Smith
Affiliation:
Georgia Emerging Infections Program, Atlanta, Georgia Atlanta Veterans’ Affairs Medical Center, Decatur, Georgia Foundation for Atlanta Veterans’ Education & Research, Decatur, Georgia
Mary Elizabeth Sexton
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Monica M. Farley
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Georgia Emerging Infections Program, Atlanta, Georgia Atlanta Veterans’ Affairs Medical Center, Decatur, Georgia
Sarah W. Satola
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Georgia Emerging Infections Program, Atlanta, Georgia Atlanta Veterans’ Affairs Medical Center, Decatur, Georgia
Jesse T. Jacob
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Georgia Emerging Infections Program, Atlanta, Georgia
*
Author for correspondence: Jessica Howard-Anderson, E-mail: Jrhowa4@emory.edu
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Abstract

Objective:

To describe the epidemiology of carbapenem-resistant Enterobacterales (CRE) bacteriuria and to determine whether urinary catheters increase the risk of subsequent CRE bacteremia.

Design:

Using active population- and laboratory-based surveillance we described a cohort of patients with incident CRE bacteriuria and identified risk factors for developing CRE bacteremia within 1 year.

Setting:

The study was conducted among the 8 counties of Georgia Health District 3 (HD3) in Atlanta, Georgia.

Patients:

Residents of HD3 with CRE first identified in urine between 2012 and 2017.

Results:

We identified 464 patients with CRE bacteriuria (mean yearly incidence, 1.96 cases per 100,000 population). Of 425 with chart review, most had a urinary catheter (56%), and many resided in long-term care facilities (48%), had a Charlson comorbidity index >3 (38%) or a decubitus ulcer (37%). 21 patients (5%) developed CRE bacteremia with the same organism within 1 year. Risk factors for subsequent bacteremia included presence of a urinary catheter (odds ratio [OR], 8.0; 95% confidence interval [CI], 1.8–34.9), central venous catheter (OR, 4.3; 95% CI, 1.7–10.6) or another indwelling device (OR, 4.3; 95% CI, 1.6–11.4), urine culture obtained as an inpatient (OR, 5.7; 95% CI, 1.3–25.9), and being in the ICU in the week prior to urine culture (OR, 2.9; 95% CI, 1.1–7.8). In a multivariable analysis, urinary catheter increased the risk of CRE bacteremia (OR, 5.3; 95% CI, 1.2–23.6).

Conclusions:

In patients with CRE bacteriuria, urinary catheters increase the risk of CRE bacteremia. Future interventions should aim to reduce inappropriate insertion and early removal of urinary catheters.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 8 , August 2021 , pp. 962 - 967
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Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION: A preliminary version of this work was presented at ID Week on October 3, 2019, in Washington, DC.

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