Characteristics of community-acquired carbapenem-resistant Enterobacterales
Rima Shrestha, Courtney Luterbach, Weixiao Dai, Lauren Komarow, Michelle Earley, Gregory Weston, Erica Herc, Jesse T. Jacob, Robert A. Salata, Darren Wong, Deverick J. Anderson, Kirsten Rydell, Cesar A Arias, Liang Chen, David van Duin, MDRO Investigators, Gregory Weston, Belinda Ostrowsky, Judith J. Lok, Robert A. Bonomo, Tatiana Domitrovic, Kristine M. Hujer, Andrea M. Hujer, Susan D. Rudin, Steven H. Marshall, Robert A. Salata, Federico Pérez, Eric Cober, Sandra S. Richter, Rebekka M. Arias, Carol Hill, Vance G. Fowler, Deverick J. Anderson, Jesse T. Jacob, Minggui Wang, Liang Chen, Samit Desai, Barry N Kreiswirth, Claudia Manca, José R. Mediavilla, Gopi Patel, W. Charles Huskins, Robin Patel, Sara Revolinski, Glenn Wortmann, Robert C. Kalayjian, Angela Kim, Julia Garcia‐Diaz, Bettina C. Fries, Brandon Eilertson, Jason C Gallagher, Michelle Earley, Scott Evans, Lauren Komarow, Omai B. Garner, Henry F. Chambers, John J. Farrell, Lilian M. Abbo, Keith S. Kaye, Courtney Luterbach, David van Duin, Jennifer Han, Yohei Doi, David L. Paterson, Darren Wong, Cesar A Arias, Blake Hanson, An Q Dinh, Diana Panesso, William C. Shropshire, Truc T. Tran, Ritu Banerjee, Sorabh Dhar, Michael J. Satlin, Matthew Grant
Abstract
BACKGROUND: Community-acquired carbapenem-resistant Enterobacterales (CA-CRE) are an important threat. METHODS: In CRACKLE-2, we defined patients with CA-CRE as admitted from home, without pre-existing conditions, and a positive culture within 48 h of admission. Healthcare-associated CRE (HA-CRE) were those with the lowest likelihood of community acquisition, not admitted from home and cultured >48 h after admission. Specific genetic markers in carbapenemase-producing Klebsiella pneumoniae were evaluated through random forest modelling. RESULTS: CA-CRE and HA-CRE were detected in 83 (10%) and 208 (26%) of 807 patients. No significant differences were observed in bacterial species or strain type distribution. K. pneumoniae (204/291, 70%) was the most common CRE species, of these 184/204 (90%) were carbapenemase producers (CPKP). The top three genetic markers in random forest models were kpi_SA15, fimE, and kpfC. Of these, kpi_SA15 (which encodes a chaperone/usher system) was positively associated (OR 3.14, 95% CI 1.13-8.87, P = 0.026), and kpfC negatively associated (OR 0.21, 95% CI 0.05-0.72, P = 0.015) with CA-CPKP. CONCLUSIONS: Ten percent of CDC-defined CRE were CA. The true proportion of CA-CRE in hospitalized patients is likely lower as patients may have had unrecorded prior healthcare exposure. The kpi_SA15 operon was associated with the CA phenotype.