Carbapenem-Resistant Enterobacteriaceae infections in patients on renal replacement therapy

For the Antibacterial Resistance Leadership Group

Research output: Contribution to journalArticle

Abstract

Background. Patients on chronic intermittent renal replacement therapy (RRT) are at risk for infection with carbapenem-resistant Enterobacteriaceae (CRE). However, the impact of RRT on outcomes after CRE infections remains to be defined. Here we perform a comparison of outcomes for CRE-infected patients with preserved renal function compared with CRE-infected patients on RRT. Methods. Cases and controls were defined from a prospective cohort of CRE-infected patients from the Consortium on Resistance against Carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE). Cases were defined as CRE-infected patients on RRT at hospital admission, while controls were defined as CRE-infected patients with serum creatinine < 2 mg/dL and not receiving RRT at admission. Risk factors for 28-day in-hospital mortality were assessed using multivariable logistic regression. An ordinal ranking of outcomes by desirability analysis was performed. Results. Patients on RRT were more likely to have diabetes mellitus and cardiac disease than controls. Urinary sources of infection were less common in the RRT group. In RRT patients, 28-day in-hospital mortality was increased as compared with controls: 22/71 (31%) vs 33/295 (11%). RRT remained significantly associated with 28-day in-hospital mortality after adjustment for source of infection, prehospitalization origin, and severity of illness (adjusted odds ratio, 2.27; 95% confidence interval [CI], 1.09-4.68; P =.03). Using univariable desirability of outcome ranking analysis, RRT status was associated with a 68% (95% CI, 61%-74%) chance of a worse disposition outcome. Conclusions. Chronic RRT in CRE-infected patients is associated with increased in-hospital mortality and worse disposition outcomes at 28 days.

Original languageEnglish
Pages (from-to)1-6
Number of pages6
JournalOpen Forum Infectious Diseases
Volume4
Issue number4
DOIs
Publication statusPublished - 01-01-2017

Fingerprint

Enterobacteriaceae Infections
Carbapenems
Renal Replacement Therapy
Enterobacteriaceae
Hospital Mortality
Infection
Confidence Intervals
Klebsiella

All Science Journal Classification (ASJC) codes

  • Oncology
  • Clinical Neurology

Cite this

For the Antibacterial Resistance Leadership Group. / Carbapenem-Resistant Enterobacteriaceae infections in patients on renal replacement therapy. In: Open Forum Infectious Diseases. 2017 ; Vol. 4, No. 4. pp. 1-6.
@article{2c389d0a75844a45bb7d4fd6a331c87c,
title = "Carbapenem-Resistant Enterobacteriaceae infections in patients on renal replacement therapy",
abstract = "Background. Patients on chronic intermittent renal replacement therapy (RRT) are at risk for infection with carbapenem-resistant Enterobacteriaceae (CRE). However, the impact of RRT on outcomes after CRE infections remains to be defined. Here we perform a comparison of outcomes for CRE-infected patients with preserved renal function compared with CRE-infected patients on RRT. Methods. Cases and controls were defined from a prospective cohort of CRE-infected patients from the Consortium on Resistance against Carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE). Cases were defined as CRE-infected patients on RRT at hospital admission, while controls were defined as CRE-infected patients with serum creatinine < 2 mg/dL and not receiving RRT at admission. Risk factors for 28-day in-hospital mortality were assessed using multivariable logistic regression. An ordinal ranking of outcomes by desirability analysis was performed. Results. Patients on RRT were more likely to have diabetes mellitus and cardiac disease than controls. Urinary sources of infection were less common in the RRT group. In RRT patients, 28-day in-hospital mortality was increased as compared with controls: 22/71 (31{\%}) vs 33/295 (11{\%}). RRT remained significantly associated with 28-day in-hospital mortality after adjustment for source of infection, prehospitalization origin, and severity of illness (adjusted odds ratio, 2.27; 95{\%} confidence interval [CI], 1.09-4.68; P =.03). Using univariable desirability of outcome ranking analysis, RRT status was associated with a 68{\%} (95{\%} CI, 61{\%}-74{\%}) chance of a worse disposition outcome. Conclusions. Chronic RRT in CRE-infected patients is associated with increased in-hospital mortality and worse disposition outcomes at 28 days.",
author = "{For the Antibacterial Resistance Leadership Group} and Brandon Eilertson and Eric Cober and Richter, {Sandra S.} and Federico Perez and Salata, {Robert A.} and Kalayjian, {Robert C.} and Watkins, {Richard R.} and Yohei Doi and Kaye, {Keith S.} and Scott Evans and Fowler, {Vance G.} and Bonomo, {Robert A.} and Jack DeHovitz and Barry Kreiswirth and {van Duin}, David",
year = "2017",
month = "1",
day = "1",
doi = "10.1093/ofid/ofx216",
language = "English",
volume = "4",
pages = "1--6",
journal = "Open Forum Infectious Diseases",
issn = "2328-8957",
publisher = "Oxford University Press",
number = "4",

}

Carbapenem-Resistant Enterobacteriaceae infections in patients on renal replacement therapy. / For the Antibacterial Resistance Leadership Group.

In: Open Forum Infectious Diseases, Vol. 4, No. 4, 01.01.2017, p. 1-6.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Carbapenem-Resistant Enterobacteriaceae infections in patients on renal replacement therapy

AU - For the Antibacterial Resistance Leadership Group

AU - Eilertson, Brandon

AU - Cober, Eric

AU - Richter, Sandra S.

AU - Perez, Federico

AU - Salata, Robert A.

AU - Kalayjian, Robert C.

AU - Watkins, Richard R.

AU - Doi, Yohei

AU - Kaye, Keith S.

AU - Evans, Scott

AU - Fowler, Vance G.

AU - Bonomo, Robert A.

AU - DeHovitz, Jack

AU - Kreiswirth, Barry

AU - van Duin, David

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background. Patients on chronic intermittent renal replacement therapy (RRT) are at risk for infection with carbapenem-resistant Enterobacteriaceae (CRE). However, the impact of RRT on outcomes after CRE infections remains to be defined. Here we perform a comparison of outcomes for CRE-infected patients with preserved renal function compared with CRE-infected patients on RRT. Methods. Cases and controls were defined from a prospective cohort of CRE-infected patients from the Consortium on Resistance against Carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE). Cases were defined as CRE-infected patients on RRT at hospital admission, while controls were defined as CRE-infected patients with serum creatinine < 2 mg/dL and not receiving RRT at admission. Risk factors for 28-day in-hospital mortality were assessed using multivariable logistic regression. An ordinal ranking of outcomes by desirability analysis was performed. Results. Patients on RRT were more likely to have diabetes mellitus and cardiac disease than controls. Urinary sources of infection were less common in the RRT group. In RRT patients, 28-day in-hospital mortality was increased as compared with controls: 22/71 (31%) vs 33/295 (11%). RRT remained significantly associated with 28-day in-hospital mortality after adjustment for source of infection, prehospitalization origin, and severity of illness (adjusted odds ratio, 2.27; 95% confidence interval [CI], 1.09-4.68; P =.03). Using univariable desirability of outcome ranking analysis, RRT status was associated with a 68% (95% CI, 61%-74%) chance of a worse disposition outcome. Conclusions. Chronic RRT in CRE-infected patients is associated with increased in-hospital mortality and worse disposition outcomes at 28 days.

AB - Background. Patients on chronic intermittent renal replacement therapy (RRT) are at risk for infection with carbapenem-resistant Enterobacteriaceae (CRE). However, the impact of RRT on outcomes after CRE infections remains to be defined. Here we perform a comparison of outcomes for CRE-infected patients with preserved renal function compared with CRE-infected patients on RRT. Methods. Cases and controls were defined from a prospective cohort of CRE-infected patients from the Consortium on Resistance against Carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE). Cases were defined as CRE-infected patients on RRT at hospital admission, while controls were defined as CRE-infected patients with serum creatinine < 2 mg/dL and not receiving RRT at admission. Risk factors for 28-day in-hospital mortality were assessed using multivariable logistic regression. An ordinal ranking of outcomes by desirability analysis was performed. Results. Patients on RRT were more likely to have diabetes mellitus and cardiac disease than controls. Urinary sources of infection were less common in the RRT group. In RRT patients, 28-day in-hospital mortality was increased as compared with controls: 22/71 (31%) vs 33/295 (11%). RRT remained significantly associated with 28-day in-hospital mortality after adjustment for source of infection, prehospitalization origin, and severity of illness (adjusted odds ratio, 2.27; 95% confidence interval [CI], 1.09-4.68; P =.03). Using univariable desirability of outcome ranking analysis, RRT status was associated with a 68% (95% CI, 61%-74%) chance of a worse disposition outcome. Conclusions. Chronic RRT in CRE-infected patients is associated with increased in-hospital mortality and worse disposition outcomes at 28 days.

UR - http://www.scopus.com/inward/record.url?scp=85052663730&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85052663730&partnerID=8YFLogxK

U2 - 10.1093/ofid/ofx216

DO - 10.1093/ofid/ofx216

M3 - Article

VL - 4

SP - 1

EP - 6

JO - Open Forum Infectious Diseases

JF - Open Forum Infectious Diseases

SN - 2328-8957

IS - 4

ER -