Abstract
Objectives
To identify risk factors for mortality in a cohort of carbapenem-resistant enterobacteriaceae
(CRE) carriers, focusing on immunosuppression and other risk factors known at the
time of CRE carriage detection.
Methods
We prospectively followed all new and known CRE carriers admitted between June 2016
and June 2017 to a single tertiary center in Israel. Patients were included in the
study after confirmation of the carrier state. Demographic and clinical data were
documented on admission or CRE acquisition and patients were followed prospectively
post-discharge until January 2018 or death. Risk factors for mortality known at the
time of the first encounter with a CRE carrier were sought. Adjusted hazard ratios
(HR) for mortality at end of follow-up with 95% confidence intervals (CI) were assessed
using Cox regression analysis.
Results
A total of 115 patients were included in the analysis. During the study period, 66
(57.4%) patients died. Immunosuppression was associated with mortality (HR 1.95, CI
95% 1.12–3.44), adjusted to the Charlson co-morbidity score, functional status, chronic
renal disease and Klebsiella pneumonia CRE, the latter three also significantly associated with mortality. CRE bacteremia
occurred among 24 (20.9%) carriers during follow up, more frequently among immunosuppressed
patients and was significantly associated with mortality at end of follow-up (p = 0.015).
Conclusion
Immunosuppression is independently associated with mortality among CRE carriers, possibly
related to CRE bacteremia that is frequent among these patients. Further research
is needed on interventions to prevent deaths among CRE carriers.
Keywords
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Article info
Publication history
Published online: October 09, 2018
Accepted:
October 6,
2018
Received in revised form:
September 30,
2018
Received:
June 1,
2018
Identification
Copyright
© 2018 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
