TY - JOUR
T1 - A matched case-case-control study of the impact of clinical outcomes and risk factors of patients with imp-type carbapenemase-producing carbapenem-resistant enterobacteriaceae in japan
AU - Saito, Sho
AU - Hayakawa, Kayoko
AU - Tsuzuki, Shinya
AU - Ishikane, Masahiro
AU - Nagashima, Maki
AU - Mezaki, Kazuhisa
AU - Sugiki, Yuko
AU - Tajima, Taichi
AU - Matsunaga, Nobuaki
AU - Ide, Satoshi
AU - Kinoshita, Noriko
AU - Kusama, Yoshiki
AU - Fujitomo, Yumiko
AU - Nakamoto, Takato
AU - Toda, Yuta
AU - Kaku, Mitsuo
AU - Kodama, Eiichi N.
AU - Ohmagari, Norio
N1 - Funding Information:
This work was supported by Japan Society for the Promotion of Science (JSPS) KAKENHI (grant JP19K19450) and a grant for international health research from the Ministry of Health, Labor, and Welfare of Japan (grant 28S-1106).
Funding Information:
S.S. received a grant from Shionogi, and N.O. received grants from Sanofi Pasteur and Eiken. The other authors have nothing to declare.
Publisher Copyright:
© 2021 American Society for Microbiology. All rights reserved.
PY - 2021/3
Y1 - 2021/3
N2 - IMP-type carbapenemase, found in various Gram-negative bacteria, has been increasingly detected worldwide. We aimed to study the outcomes and risk factors for acquisition of IMP-type carbapenemase-producing carbapenem-resistant Enterobacteriaceae (IMP-CRE), as this has not been evaluated in detail. We conducted a matched case-case-control study of patients from whom IMP-CRE isolates were obtained. All patients who tested positive for IMP-CRE were included; they were matched with patients with carbapenem-susceptible Enterobacteriaceae (CSE) and with controls at a ratio of 1:1:2. The risk factors for acquisition for the CRE and CSE groups and mortality rates, which were calculated using multivariate logistic regression models with weighting according to the inverse probability of propensity scores, were compared. In total, 192 patients (96 patients each in the CRE and CSE groups, with 130 Enterobacter cloacae isolates and 62 Klebsiella sp. isolates) were included. The IMP-11 type was present in 43 patients, IMP-1 in 33, and IMP-60 and IMP-66 in 1 each; 31 patients with CRE (32.3%) and 34 with CSE (35.4%) developed infections. Multivariate analysis identified the following independent risk factors: Gastrostomy, history of intravenous therapy or hemodialysis, and previous exposure to broad-spectrum β-lactam antibiotics, including penicillin with β-lactamase inhibitors, cephalosporins, and carbapenems. In propensity score-adjusted analysis, mortality rates for the CRE and CSE groups were similar (15.0% and 19.5%, respectively). We found that IMP-CRE may not contribute to worsened clinical outcomes, compared to CSE, and gastrostomy, previous intravenous therapy, hemodialysis, and broad-spectrum antimicrobial exposure were identified as risk factors for CRE isolation. Fluoroquinolone and aminoglycosides are potentially useful antibiotics for IMP-CRE infections.
AB - IMP-type carbapenemase, found in various Gram-negative bacteria, has been increasingly detected worldwide. We aimed to study the outcomes and risk factors for acquisition of IMP-type carbapenemase-producing carbapenem-resistant Enterobacteriaceae (IMP-CRE), as this has not been evaluated in detail. We conducted a matched case-case-control study of patients from whom IMP-CRE isolates were obtained. All patients who tested positive for IMP-CRE were included; they were matched with patients with carbapenem-susceptible Enterobacteriaceae (CSE) and with controls at a ratio of 1:1:2. The risk factors for acquisition for the CRE and CSE groups and mortality rates, which were calculated using multivariate logistic regression models with weighting according to the inverse probability of propensity scores, were compared. In total, 192 patients (96 patients each in the CRE and CSE groups, with 130 Enterobacter cloacae isolates and 62 Klebsiella sp. isolates) were included. The IMP-11 type was present in 43 patients, IMP-1 in 33, and IMP-60 and IMP-66 in 1 each; 31 patients with CRE (32.3%) and 34 with CSE (35.4%) developed infections. Multivariate analysis identified the following independent risk factors: Gastrostomy, history of intravenous therapy or hemodialysis, and previous exposure to broad-spectrum β-lactam antibiotics, including penicillin with β-lactamase inhibitors, cephalosporins, and carbapenems. In propensity score-adjusted analysis, mortality rates for the CRE and CSE groups were similar (15.0% and 19.5%, respectively). We found that IMP-CRE may not contribute to worsened clinical outcomes, compared to CSE, and gastrostomy, previous intravenous therapy, hemodialysis, and broad-spectrum antimicrobial exposure were identified as risk factors for CRE isolation. Fluoroquinolone and aminoglycosides are potentially useful antibiotics for IMP-CRE infections.
KW - Carbapenem resistance
KW - Clinical outcomes
KW - Enterobacteriaceae
KW - IMP
KW - Propensity score
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UR - http://www.scopus.com/inward/citedby.url?scp=85101748972&partnerID=8YFLogxK
U2 - 10.1128/AAC.01483-20
DO - 10.1128/AAC.01483-20
M3 - Article
C2 - 33257451
AN - SCOPUS:85101748972
SN - 0066-4804
VL - 65
JO - Antimicrobial Agents and Chemotherapy
JF - Antimicrobial Agents and Chemotherapy
IS - 3
M1 - e01483-20
ER -
