Shrestha R, Luterbach CL, Dai W, Komarow L, Earley M, Weston G, Herc E, Jacob JT, Salata R, Wong D, Anderson D, Rydell KB, Arias CA, Chen L, and van Duin D. Characteristics of community-acquired carbapenem-resistant Enterobacterales. J Antimicrob Chemother 2022; 77(10):2763-2771.
The Journal of antimicrobial chemotherapy
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.
Medical Subject Headings
Anti-Bacterial Agents; Bacterial Proteins; Carbapenem-Resistant Enterobacteriaceae; Carbapenems; Enterobacteriaceae Infections; Genetic Markers; Humans; Klebsiella pneumoniae; beta-Lactamases