Risk Factors and Outcomes of Bacteremia Caused by Carbapenem Resistant Enterobacterales Compared to Carbapenem Susceptible Enterobacterales

Abstract BackgroundDue to shrinking therapeutic options, infections due to Carbapenem-resistant Enterobacterales (CRE) are an urgent threat in healthcare systems. We compared the risk factors and outcomes of bacteremia secondary to CRE with bacteremia secondary to carbapenem susceptible Enterobacterales (CSE).MethodsWe conducted a retrospective cross-sectional study on patients admitted to a tertiary care hospital in Karachi, Pakistan between 2013 and 2016. Patients with CRE bacteremia were matched to those with CSE bacteremia while excluding those with polymicrobial cultures.ResultsA total of 131 patients were enrolled (65 CRE and 66 CSE) with the mean age of 51.8 years and 57.1 years in CRE and CSE groups respectively. Compared with CSE, CRE bacteremia was more likely to occur in patients with Diabetes Mellitus or those with a tracheostomy (P = 0.002 and 0.014, respectively). The most common source of CRE bacteremia was central line associated (24.6% of all cases) as opposed to urinary tract infections in those with CSE bacteremia (62.1% of all cases). Fewer patients with CRE bacteremia received appropriate antibiotics (72.3% vs. 81.8%). Mortality was significantly higher in the CRE group (41.5% vs. 12.1%, P = 0.001) even when adjusted for the severity of illness using the PITT-bacteremia score. Increased mortality was also associated with central venous catheterization in both groups. The median length of hospital stay was longer in patients with CRE (8 vs. 6 days, P = 0.021)ConclusionCRE bacteremia was associated with central lines and led to significantly higher mortality and length of stay.