A prospective observational study of the epidemiology, management, and outcomes of skin and soft tissue infections due to carbapenem-resistant Enterobacteriaceae

For the Antibacterial Resistance Leadership Group

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background. This study was performed to characterize the epidemiology, management, and outcomes of skin and soft tissue infection (SSTI) and colonization due to carbapenem-resistant Enterobacteriaceae (CRE). Methods. Patients from the Consortium on Resistance Against Carbapenem in Klebsiella and Other Enterobacteriaceae (CRACKLE-1) from December 24, 2011 to October 1, 2014 with wound cultures positive for CRE were included in the study. Predictors of surgical intervention were analyzed. Molecular typing of isolates was performed using repetitive extragenic palindromic polymerase chain reaction (PCR). Carbapenemase genes were detected using PCR. Results. One hundred forty-two patients were included: 62 had SSTI (44%) and 56% were colonized. Mean age was 61 years, and 48% were male: median Charlson score was 3 (interquartile range, 1-5). Forty-eight percent of patients were admitted from longterm care facilities (LTCFs), and 31% were from the community. Two strain types (ST258A and ST258B) were identified (73% of 45 tested). Carbapenemase genes were detected in 40 of 45 isolates (blaKPC-3 [47%], blaKPC-2 [42%]). Sixty-eight patients (48%) underwent surgical intervention, 63% of whom had SSTI. Patients admitted from LTCFs were less likely to undergo surgical intervention (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.18-0.71). In multivariable analysis, among patients with SSTI, those admitted from LTCFs were less likely to undergo debridement (OR, 0.18; 95% CI, 0.04-0.93). Conclusions. Patients admitted from LTCFs with CRE SSTI were less likely to undergo surgical intervention. Sixteen percent of the patients died, and approximately 50% of survivors required more intensive care upon discharge. These findings suggest a unique, impactful syndrome within the CRE infection spectrum. Further studies are needed to assess the role of surgical debridement in management of CRE-SSTI, particularly among LTCF residents.

Original languageEnglish
Pages (from-to)1-7
Number of pages7
JournalOpen Forum Infectious Diseases
Volume4
Issue number3
DOIs
Publication statusPublished - 01-01-2017

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Soft Tissue Infections
Carbapenems
Enterobacteriaceae
Observational Studies
Epidemiology
Prospective Studies
Skin
Debridement
Enterobacteriaceae Infections
Odds Ratio
Confidence Intervals
Molecular Typing
Polymerase Chain Reaction
Klebsiella
Critical Care
Genes
Survivors
Wounds and Injuries

All Science Journal Classification (ASJC) codes

  • Oncology
  • Clinical Neurology

Cite this

@article{96ff970e0d5a4d6ca1572005446bd3d2,
title = "A prospective observational study of the epidemiology, management, and outcomes of skin and soft tissue infections due to carbapenem-resistant Enterobacteriaceae",
abstract = "Background. This study was performed to characterize the epidemiology, management, and outcomes of skin and soft tissue infection (SSTI) and colonization due to carbapenem-resistant Enterobacteriaceae (CRE). Methods. Patients from the Consortium on Resistance Against Carbapenem in Klebsiella and Other Enterobacteriaceae (CRACKLE-1) from December 24, 2011 to October 1, 2014 with wound cultures positive for CRE were included in the study. Predictors of surgical intervention were analyzed. Molecular typing of isolates was performed using repetitive extragenic palindromic polymerase chain reaction (PCR). Carbapenemase genes were detected using PCR. Results. One hundred forty-two patients were included: 62 had SSTI (44{\%}) and 56{\%} were colonized. Mean age was 61 years, and 48{\%} were male: median Charlson score was 3 (interquartile range, 1-5). Forty-eight percent of patients were admitted from longterm care facilities (LTCFs), and 31{\%} were from the community. Two strain types (ST258A and ST258B) were identified (73{\%} of 45 tested). Carbapenemase genes were detected in 40 of 45 isolates (blaKPC-3 [47{\%}], blaKPC-2 [42{\%}]). Sixty-eight patients (48{\%}) underwent surgical intervention, 63{\%} of whom had SSTI. Patients admitted from LTCFs were less likely to undergo surgical intervention (odds ratio [OR], 0.36; 95{\%} confidence interval [CI], 0.18-0.71). In multivariable analysis, among patients with SSTI, those admitted from LTCFs were less likely to undergo debridement (OR, 0.18; 95{\%} CI, 0.04-0.93). Conclusions. Patients admitted from LTCFs with CRE SSTI were less likely to undergo surgical intervention. Sixteen percent of the patients died, and approximately 50{\%} of survivors required more intensive care upon discharge. These findings suggest a unique, impactful syndrome within the CRE infection spectrum. Further studies are needed to assess the role of surgical debridement in management of CRE-SSTI, particularly among LTCF residents.",
author = "{For the Antibacterial Resistance Leadership Group} and Oryan Henig and Eric Cober and Richter, {Sandra S.} and Federico Perez and Salata, {Robert A.} and Kalayjian, {Robert C.} and Watkins, {Richard R.} and Steve Marshall and Rudin, {Susan D.} and Domitrovic, {Nicholas N.} and Hujer, {Andrea M.} and Hujer, {Kristine M.} and Yohei Doi and Scott Evans and Fowler, {Vance G.} and Bonomo, {Robert A.} and {van Duin}, David and Kaye, {Keith S.}",
year = "2017",
month = "1",
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doi = "10.1093/ofid/ofx157",
language = "English",
volume = "4",
pages = "1--7",
journal = "Open Forum Infectious Diseases",
issn = "2328-8957",
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A prospective observational study of the epidemiology, management, and outcomes of skin and soft tissue infections due to carbapenem-resistant Enterobacteriaceae. / For the Antibacterial Resistance Leadership Group.

In: Open Forum Infectious Diseases, Vol. 4, No. 3, 01.01.2017, p. 1-7.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A prospective observational study of the epidemiology, management, and outcomes of skin and soft tissue infections due to carbapenem-resistant Enterobacteriaceae

AU - For the Antibacterial Resistance Leadership Group

AU - Henig, Oryan

AU - Cober, Eric

AU - Richter, Sandra S.

AU - Perez, Federico

AU - Salata, Robert A.

AU - Kalayjian, Robert C.

AU - Watkins, Richard R.

AU - Marshall, Steve

AU - Rudin, Susan D.

AU - Domitrovic, Nicholas N.

AU - Hujer, Andrea M.

AU - Hujer, Kristine M.

AU - Doi, Yohei

AU - Evans, Scott

AU - Fowler, Vance G.

AU - Bonomo, Robert A.

AU - van Duin, David

AU - Kaye, Keith S.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background. This study was performed to characterize the epidemiology, management, and outcomes of skin and soft tissue infection (SSTI) and colonization due to carbapenem-resistant Enterobacteriaceae (CRE). Methods. Patients from the Consortium on Resistance Against Carbapenem in Klebsiella and Other Enterobacteriaceae (CRACKLE-1) from December 24, 2011 to October 1, 2014 with wound cultures positive for CRE were included in the study. Predictors of surgical intervention were analyzed. Molecular typing of isolates was performed using repetitive extragenic palindromic polymerase chain reaction (PCR). Carbapenemase genes were detected using PCR. Results. One hundred forty-two patients were included: 62 had SSTI (44%) and 56% were colonized. Mean age was 61 years, and 48% were male: median Charlson score was 3 (interquartile range, 1-5). Forty-eight percent of patients were admitted from longterm care facilities (LTCFs), and 31% were from the community. Two strain types (ST258A and ST258B) were identified (73% of 45 tested). Carbapenemase genes were detected in 40 of 45 isolates (blaKPC-3 [47%], blaKPC-2 [42%]). Sixty-eight patients (48%) underwent surgical intervention, 63% of whom had SSTI. Patients admitted from LTCFs were less likely to undergo surgical intervention (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.18-0.71). In multivariable analysis, among patients with SSTI, those admitted from LTCFs were less likely to undergo debridement (OR, 0.18; 95% CI, 0.04-0.93). Conclusions. Patients admitted from LTCFs with CRE SSTI were less likely to undergo surgical intervention. Sixteen percent of the patients died, and approximately 50% of survivors required more intensive care upon discharge. These findings suggest a unique, impactful syndrome within the CRE infection spectrum. Further studies are needed to assess the role of surgical debridement in management of CRE-SSTI, particularly among LTCF residents.

AB - Background. This study was performed to characterize the epidemiology, management, and outcomes of skin and soft tissue infection (SSTI) and colonization due to carbapenem-resistant Enterobacteriaceae (CRE). Methods. Patients from the Consortium on Resistance Against Carbapenem in Klebsiella and Other Enterobacteriaceae (CRACKLE-1) from December 24, 2011 to October 1, 2014 with wound cultures positive for CRE were included in the study. Predictors of surgical intervention were analyzed. Molecular typing of isolates was performed using repetitive extragenic palindromic polymerase chain reaction (PCR). Carbapenemase genes were detected using PCR. Results. One hundred forty-two patients were included: 62 had SSTI (44%) and 56% were colonized. Mean age was 61 years, and 48% were male: median Charlson score was 3 (interquartile range, 1-5). Forty-eight percent of patients were admitted from longterm care facilities (LTCFs), and 31% were from the community. Two strain types (ST258A and ST258B) were identified (73% of 45 tested). Carbapenemase genes were detected in 40 of 45 isolates (blaKPC-3 [47%], blaKPC-2 [42%]). Sixty-eight patients (48%) underwent surgical intervention, 63% of whom had SSTI. Patients admitted from LTCFs were less likely to undergo surgical intervention (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.18-0.71). In multivariable analysis, among patients with SSTI, those admitted from LTCFs were less likely to undergo debridement (OR, 0.18; 95% CI, 0.04-0.93). Conclusions. Patients admitted from LTCFs with CRE SSTI were less likely to undergo surgical intervention. Sixteen percent of the patients died, and approximately 50% of survivors required more intensive care upon discharge. These findings suggest a unique, impactful syndrome within the CRE infection spectrum. Further studies are needed to assess the role of surgical debridement in management of CRE-SSTI, particularly among LTCF residents.

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U2 - 10.1093/ofid/ofx157

DO - 10.1093/ofid/ofx157

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VL - 4

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JO - Open Forum Infectious Diseases

JF - Open Forum Infectious Diseases

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