Epidemiology of and risk factors for mortality due to carbapenemase-producing organisms (CPO) in healthcare facilities

Shengyuan Zhao; Sharon Kennedy; Meghan R Perry; Julie Wilson; Margo Chase-Topping; Eleanor Anderson; Mark E J Woolhouse; Michael Lockhart

doi:10.1016/j.jhin.2021.01.028

Epidemiology of and risk factors for mortality due to carbapenemase-producing organisms (CPO) in healthcare facilities

Shengyuan Zhao, Sharon Kennedy, Meghan R Perry, Julie Wilson, Margo Chase-Topping, Eleanor Anderson, Mark E J Woolhouse, Michael Lockhart

Research output: Contribution to journal › Article › peer-review

Abstract / Description of output

BACKGROUND: Carbapenemase-producing organisms (CPO) have been largely responsible for extensive spread of carbapenem resistance and their prevalence is increasing in many parts of the world.

AIM: To evaluate clinical and molecular epidemiology and mortality associated with CPO among patients.

METHODS: All CPO from clinical and long-term healthcare surveillance cultures across Scotland in 2003-2017 were retrospectively reviewed. Polymerase chain reaction was used to detect genes coding for carbapenemases. A generalised linear mixed model was used to identify risk factors for mortality.

FINDINGS: A total of 290 individuals with CPO were identified. The overall incidence increased over time (P<0.001), from 0.02 to 1.38 per 100,000 population between 2003 and 2017. A total of 243 distinct CPO isolates were obtained from 269 isolations in 214 individuals with available metadata. The majority of the isolates were Enterobacterales (206/243, 84.8%) with Klebsiella pneumoniae (65/206, 31.6%) and Enterobacter cloacae (52/206, 25.2%) the most common species. VIM (75/243, 30.9%) and NDM (56/243, 23.0%) were the most common carbapenemases. The crude 30-day mortality rate was 11.8% (25/211) while the case fatality rate was 5.7% (12/211). Age over 60 years (adjusted odds ratio, aOR 3.36, 95% confidence interval, 95%CI 1.06-10.63, P=0.033), non-fermenters presence (aOR 4.88, 95%CI 1.64-14.47, P=0.005) and systemic infection or organ failure (aOR 4.21, 95%CI 1.38-12.81, P=0.032) were independently associated with 30-day mortality.

CONCLUSION: CPO incidence in Scotland is low but increasing. Awareness is required that inpatients older than 60 years, with systemic infection or organ failure or presenting non-fermenters are at higher mortality risk from CPO.

Original language	English
Journal	Journal of Hospital Infection
Early online date	8 Feb 2021
DOIs	https://doi.org/10.1016/j.jhin.2021.01.028
Publication status	E-pub ahead of print - 8 Feb 2021

Keywords / Materials (for Non-textual outputs)

carbapenemase
epidemiology
mortality
risk factors

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10.1016/j.jhin.2021.01.028

PIIS0195670121000499
The Authors. Published by Elsevier Ltd on behalf of The Healthcare Infection Society. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Final published version, 793 KBLicence: CC BY-NC-ND

Cite this

@article{20dbbf2d632345468a51811b605151bb,

title = "Epidemiology of and risk factors for mortality due to carbapenemase-producing organisms (CPO) in healthcare facilities",

abstract = "BACKGROUND: Carbapenemase-producing organisms (CPO) have been largely responsible for extensive spread of carbapenem resistance and their prevalence is increasing in many parts of the world.AIM: To evaluate clinical and molecular epidemiology and mortality associated with CPO among patients.METHODS: All CPO from clinical and long-term healthcare surveillance cultures across Scotland in 2003-2017 were retrospectively reviewed. Polymerase chain reaction was used to detect genes coding for carbapenemases. A generalised linear mixed model was used to identify risk factors for mortality.FINDINGS: A total of 290 individuals with CPO were identified. The overall incidence increased over time (P<0.001), from 0.02 to 1.38 per 100,000 population between 2003 and 2017. A total of 243 distinct CPO isolates were obtained from 269 isolations in 214 individuals with available metadata. The majority of the isolates were Enterobacterales (206/243, 84.8%) with Klebsiella pneumoniae (65/206, 31.6%) and Enterobacter cloacae (52/206, 25.2%) the most common species. VIM (75/243, 30.9%) and NDM (56/243, 23.0%) were the most common carbapenemases. The crude 30-day mortality rate was 11.8% (25/211) while the case fatality rate was 5.7% (12/211). Age over 60 years (adjusted odds ratio, aOR 3.36, 95% confidence interval, 95%CI 1.06-10.63, P=0.033), non-fermenters presence (aOR 4.88, 95%CI 1.64-14.47, P=0.005) and systemic infection or organ failure (aOR 4.21, 95%CI 1.38-12.81, P=0.032) were independently associated with 30-day mortality.CONCLUSION: CPO incidence in Scotland is low but increasing. Awareness is required that inpatients older than 60 years, with systemic infection or organ failure or presenting non-fermenters are at higher mortality risk from CPO.",

keywords = "carbapenemase, epidemiology, mortality, risk factors",

author = "Shengyuan Zhao and Sharon Kennedy and Perry, {Meghan R} and Julie Wilson and Margo Chase-Topping and Eleanor Anderson and Woolhouse, {Mark E J} and Michael Lockhart",

note = "Copyright {\textcopyright} 2021. Published by Elsevier Ltd.",

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doi = "10.1016/j.jhin.2021.01.028",

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TY - JOUR

T1 - Epidemiology of and risk factors for mortality due to carbapenemase-producing organisms (CPO) in healthcare facilities

AU - Zhao, Shengyuan

AU - Kennedy, Sharon

AU - Perry, Meghan R

AU - Wilson, Julie

AU - Chase-Topping, Margo

AU - Anderson, Eleanor

AU - Woolhouse, Mark E J

AU - Lockhart, Michael

PY - 2021/2/8

Y1 - 2021/2/8

N2 - BACKGROUND: Carbapenemase-producing organisms (CPO) have been largely responsible for extensive spread of carbapenem resistance and their prevalence is increasing in many parts of the world.AIM: To evaluate clinical and molecular epidemiology and mortality associated with CPO among patients.METHODS: All CPO from clinical and long-term healthcare surveillance cultures across Scotland in 2003-2017 were retrospectively reviewed. Polymerase chain reaction was used to detect genes coding for carbapenemases. A generalised linear mixed model was used to identify risk factors for mortality.FINDINGS: A total of 290 individuals with CPO were identified. The overall incidence increased over time (P<0.001), from 0.02 to 1.38 per 100,000 population between 2003 and 2017. A total of 243 distinct CPO isolates were obtained from 269 isolations in 214 individuals with available metadata. The majority of the isolates were Enterobacterales (206/243, 84.8%) with Klebsiella pneumoniae (65/206, 31.6%) and Enterobacter cloacae (52/206, 25.2%) the most common species. VIM (75/243, 30.9%) and NDM (56/243, 23.0%) were the most common carbapenemases. The crude 30-day mortality rate was 11.8% (25/211) while the case fatality rate was 5.7% (12/211). Age over 60 years (adjusted odds ratio, aOR 3.36, 95% confidence interval, 95%CI 1.06-10.63, P=0.033), non-fermenters presence (aOR 4.88, 95%CI 1.64-14.47, P=0.005) and systemic infection or organ failure (aOR 4.21, 95%CI 1.38-12.81, P=0.032) were independently associated with 30-day mortality.CONCLUSION: CPO incidence in Scotland is low but increasing. Awareness is required that inpatients older than 60 years, with systemic infection or organ failure or presenting non-fermenters are at higher mortality risk from CPO.

AB - BACKGROUND: Carbapenemase-producing organisms (CPO) have been largely responsible for extensive spread of carbapenem resistance and their prevalence is increasing in many parts of the world.AIM: To evaluate clinical and molecular epidemiology and mortality associated with CPO among patients.METHODS: All CPO from clinical and long-term healthcare surveillance cultures across Scotland in 2003-2017 were retrospectively reviewed. Polymerase chain reaction was used to detect genes coding for carbapenemases. A generalised linear mixed model was used to identify risk factors for mortality.FINDINGS: A total of 290 individuals with CPO were identified. The overall incidence increased over time (P<0.001), from 0.02 to 1.38 per 100,000 population between 2003 and 2017. A total of 243 distinct CPO isolates were obtained from 269 isolations in 214 individuals with available metadata. The majority of the isolates were Enterobacterales (206/243, 84.8%) with Klebsiella pneumoniae (65/206, 31.6%) and Enterobacter cloacae (52/206, 25.2%) the most common species. VIM (75/243, 30.9%) and NDM (56/243, 23.0%) were the most common carbapenemases. The crude 30-day mortality rate was 11.8% (25/211) while the case fatality rate was 5.7% (12/211). Age over 60 years (adjusted odds ratio, aOR 3.36, 95% confidence interval, 95%CI 1.06-10.63, P=0.033), non-fermenters presence (aOR 4.88, 95%CI 1.64-14.47, P=0.005) and systemic infection or organ failure (aOR 4.21, 95%CI 1.38-12.81, P=0.032) were independently associated with 30-day mortality.CONCLUSION: CPO incidence in Scotland is low but increasing. Awareness is required that inpatients older than 60 years, with systemic infection or organ failure or presenting non-fermenters are at higher mortality risk from CPO.

KW - carbapenemase

KW - epidemiology

KW - mortality

KW - risk factors

U2 - 10.1016/j.jhin.2021.01.028

DO - 10.1016/j.jhin.2021.01.028

M3 - Article

C2 - 33571557

SN - 0195-6701

JO - Journal of Hospital Infection

JF - Journal of Hospital Infection

ER -

Epidemiology of and risk factors for mortality due to carbapenemase-producing organisms (CPO) in healthcare facilities

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