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.
- risk factors