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Marimuthu K, Ng OT, Cherng BPZ, Fong RKC, Pada SK, De PP, Ooi ST, Smitasin N, Thoon KC, Krishnan PU, Ang M, Chan DSG, Kwa ALH, Deepak RN, Chan YK, Chan YFZ, Huan X, Linn KZ, Tee NWS, Tan TY, Koh TH, Lin RTP, Hsu LY, Sengupta S, Paterson DL, Perencevich E, Harbarth S, Teo J, Venkatachalam I, CaPES study group. Antecedent Carbapenem Exposure as a Risk Factor for Non-Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (NCPCRE) and Carbapenemase-Producing Enterobacteriaceae (CPE). Antimicrobial agents and chemotherapy. 2019 Aug 5.
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Abstract: Carbapenem-resistant Enterobacteriaceae (CRE) can be mechanistically classified into carbapenemase-producing Enterobacteriaceae (CPE) and non-carbapenemase-producing carbapenem non-susceptible Enterobacteriaceae (NCPCRE). We sought to investigate the effect of antecedent carbapenem exposure as a risk factor for NCPCRE versus CPE. Among all patients with CNSE colonization and infection, we conducted a case-control study comparing patients with NCPCRE (cases) and patients with CPE (controls). Presence of carbapenemases was investigated with phenotypic tests followed by polymerase chain reaction (PCR) for predominant carbapenemase genes. We included 843 unique patients with first-episode CRE: 387 (45.9%) NCPCRE and 456 (54.1%) CPE. CPEs were mostly (42.8%), (38.4%), and (12.1%). After adjusting for confounders and clustering at the institutional level, the odds of prior 30-day carbapenem exposure was three times higher among NCPCRE compared to CPE patients [lsqb]adjusted odds ratio (aOR), 3.16; 95% confidence interval (CI), 2.19-4.55; P<0.001]. ). Odds of prior carbapenem exposure and NCPCRE detection persisted in stratified analyses by Enterobacteriaceae species ( and ) and carbapenemase gene ( and ). CPE was associated with male gender (aOR, 1.45; 95%CI, 1.07-1.97; P=0.02), intensive care unit stay (aOR, 1.84; 95%CI, 1.24-2.74; P=0.003), and hospitalization in the preceding 1 year (aOR, 1.42; 95%CI, 1.01-2.02; P=0.05). In a large nationwide study, antecedent carbapenem exposure was a significant risk factor for NCPCRE versus CPE, suggesting a differential effect of antibiotic selection pressure.