Carbapenem-resistant Enterobacterales bacteriuria and subsequent bacteremia: A population-based study.

Jessica R Howard-Anderson, Chris W Bower, Gillian Smith, Mary Elizabeth Sexton, Monica M Farley, Sarah W Satola, Jesse T Jacob

Infection control and hospital epidemiology 2021 Aug

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To describe the epidemiology of carbapenem-resistant Enterobacterales (CRE) bacteriuria and to determine whether urinary catheters increase the risk of subsequent CRE bacteremia. Using active population- and laboratory-based surveillance we described a cohort of patients with incident CRE bacteriuria and identified risk factors for developing CRE bacteremia within 1 year. The study was conducted among the 8 counties of Georgia Health District 3 (HD3) in Atlanta, Georgia. Residents of HD3 with CRE first identified in urine between 2012 and 2017. We identified 464 patients with CRE bacteriuria (mean yearly incidence, 1.96 cases per 100,000 population). Of 425 with chart review, most had a urinary catheter (56%), and many resided in long-term care facilities (48%), had a Charlson comorbidity index >3 (38%) or a decubitus ulcer (37%). 21 patients (5%) developed CRE bacteremia with the same organism within 1 year. Risk factors for subsequent bacteremia included presence of a urinary catheter (odds ratio [OR], 8.0; 95% confidence interval [CI], 1.8-34.9), central venous catheter (OR, 4.3; 95% CI, 1.7-10.6) or another indwelling device (OR, 4.3; 95% CI, 1.6-11.4), urine culture obtained as an inpatient (OR, 5.7; 95% CI, 1.3-25.9), and being in the ICU in the week prior to urine culture (OR, 2.9; 95% CI, 1.1-7.8). In a multivariable analysis, urinary catheter increased the risk of CRE bacteremia (OR, 5.3; 95% CI, 1.2-23.6). In patients with CRE bacteriuria, urinary catheters increase the risk of CRE bacteremia. Future interventions should aim to reduce inappropriate insertion and early removal of urinary catheters.

Citation

Jessica R Howard-Anderson, Chris W Bower, Gillian Smith, Mary Elizabeth Sexton, Monica M Farley, Sarah W Satola, Jesse T Jacob. Carbapenem-resistant Enterobacterales bacteriuria and subsequent bacteremia: A population-based study. Infection control and hospital epidemiology. 2021 Aug;42(8):962-967