Risk Factors and Outcomes of Patients Colonized with KPC and NDM Carbapenemase-Producing Enterobacterales

Lisa Saidel-Odes, Orli Sagi, Shani Troib, Hannah Leeman, Ronit Nativ, Tal Schlaeffer-Yosef, Hovav Azulay, Lior Nesher, Abraham Borer

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Carbapenemase-producing enterobacterales (CPE) poses an increasing threat in hospitals worldwide. Recently, the prevalence of different carbapenemases conferring carbapenem resistance in enterobacterales changed in our country, including an increase in New Delhi Metallo-beta-lactamase (NDM)-CPE. We conducted a comparative historical study of adult patients colonized with Klebsiella pneumoniae carbapenemase (KPC)-CPE (July 2016 to June 2018, a historical cohort) vs. NDM-CPE (July 2016 to January 2023). We identified patients retrospectively through the microbiology laboratory and reviewed their files, extracting demographics, underlying diseases, Charlson Comorbidity Index (CCI) scores, treatments, and outcomes. This study included 228 consecutive patients from whom a CPE rectal swab screening was obtained: 136 NDM-CPE positive and 92 KPC-CPE positive. NDM-CPE-colonized patients had a shorter hospitalization length and a significantly lower 30-day post-discharge mortality rate (p = 0.002) than KPC-CPE-colonized patients. Based on multivariate regression, independent risk factors predicting CPE-NDM colonization included admission from home and CCI < 4 (p < 0.001, p = 0.037, respectively). The increase in NDM-CPE prevalence necessitates a modified CPE screening strategy upon hospital admission tailored to the changing local CPE epidemiology. In our region, the screening of younger patients residing at home with fewer comorbidities should be considered, regardless of a prior community healthcare contact or hospital admission.

    Original languageEnglish
    Article number427
    JournalAntibiotics
    Volume13
    Issue number5
    DOIs
    StatePublished - 1 May 2024

    Keywords

    • antibiotic stewardship
    • beta-lactamase NDM
    • infection control
    • multidrug resistance

    ASJC Scopus subject areas

    • Microbiology
    • Biochemistry
    • General Pharmacology, Toxicology and Pharmaceutics
    • Microbiology (medical)
    • Infectious Diseases
    • Pharmacology (medical)

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