Changing Epidemiology of Carbapenem-Resistant Enterobacteriaceae Bloodstream Infections in United States Veterans Affairs Hospitals, 2004–2014. (4th October 2017)

• Record Type: Journal Article
• Authors: Britt, Nicholas S; Patel, Nimish; Potter, Emily M; Steed, Molly E
• Is Part Of: Open forum infectious diseases. Volume 4(2017)Supplement 1
• Page Start: S140
• Page End: S140
• Publication Date: 2017-10-04
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofx163.213
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Carbapenem-resistant Enterobacteriaceae bloodstream infections (CRE-BSI) have limited treatment options and are associated with significant mortality. Understanding the burden of CRE-BSI in the USA is critical to inform evaluations of interventions to reduce CRE-BSI rates and improve clinical outcomes. The objective of this study was to quantify the incidence of CRE-BSI over time among veterans affairs (VA) patients. Methods: A nationally representative retrospective cohort study among adult patients admitted to any VA hospital from 2004 through 2014. Carbapenem resistance was defined by CLSI breakpoints in effect during a given year. Inclusion criteria were: (i) hospital admission; (ii) age ≥18 years; (iii) ≥1 blood culture positive for an Enterobacteriaceae species demonstrating resistance to ≥1 carbapenem agent per 2015 CDC CRE definitions (including ertapenem). In recurrent CRE-BSI, only the first case was included. Incidence densities of CRE-BSI were compared year-by-year (overall and by CRE species category) using linear regression analysis. Results: A total of 1, 301 CRE-BSI cases were observed over the study period, corresponding to an overall incidence of 1.79 cases/10, 000 hospitalizations. There was a profound increase in the incidence of CRE-BSI from 1.08 cases/10, 000 hospitalizations in 2004 to 2.24 cases/10, 000 hospitalizations in 2009. Following a decrease in incidence in 2010 (1.61 cases/10, 000 hospitalizations), rates of CRE-BSI increased again by 2014 (1.90 cases/10, 000 hospitalizations). The majority of CRE-BSI cases were due to Klebsiella pneumoniae ( n = 638; 49.0%), followed by Enterobacter species ( n = 188; 14.5%), Proteus species ( n = 148; 11.1%), and Escherichia coli ( n = 120; 9.2%). The incidence of CRE-BSI caused by Proteus species increased from 0.19 cases/10, 000 hospitalizations in 2009 to 0.38 cases/10, 000 hospitalizations in 2014. In contrast, the incidence of CRE-BSI caused by E. coli decreased from 0.29 cases/10, 000 hospitalizations in 2009 to 0.10 cases/10, 000 hospitalizations in 2014. Conclusion: In a national sample of hospitalized VA patients, marked changes in the incidence of CRE-BSI were observed from 2004 to 2014. Rates of CRE-BSI caused by Proteus species appear to be increasing and rates of CRE-BSI caused by E. coli appear to be decreasing. Disclosures: N. S. Britt, Merck & Co., Inc.: Grant Investigator, Consulting fee Gilead Sciences, Inc.: Grant Investigator, Consulting fee. N. Patel, Gilead Sciences, Inc.: Grant Investigator, Research grant. Merck & Co., Inc.: Grant Investigator, Consulting fee. Theravance Biopharma US, Inc.: Board Member and Speaker's Bureau, Speaker honorarium. M. E. Steed, Merck & Co., Inc.: Grant Investigator, Research grant.