Selected Bivariable Analyses Comparing Risk Factors and Outcomes of Patients With Non-CP-CRE, Shamir (Assaf Harofeh) Medical Center (November 2014–December 2016), (n = 109 in Each Group)
| . | . | . | . | . | Non-CP-CRE vs Uninfected . | Susceptible Enterobacteriaceae vs Uninfected . | CRE vs Susceptible Enterobacteriaceae . | |||
|---|---|---|---|---|---|---|---|---|---|---|
| Parameter . | . | Non-CP-CRE No. (%)a . | Susceptible Enterobacteriaceae No. (%)a . | Uninfected Controls No. (%)a . | OR (95% CI) . | P Value . | OR (95% CI) . | P Value . | OR (95% CI) . | P Value . |
| Demographics | ||||||||||
| Age (years), median (IQR) | 76 (64–84) | 75 (63–84) | 76 (64–91) | .9 | .6 | .6 | ||||
| Age group | Pediatrics (<16 years) | 2 (1.8) | 2 (1.8) | 2 (1.8) | - | - | - | - | - | - |
| Elderly (>65 years) | 80 (73.4) | 80 (73.4) | 80 (73.4) | - | - | - | - | - | - | |
| Female gender | 49 (45.0) | 58 (53.2) | 53 (48.6) | 0.9 (0.5–1.5) | .6 | 1.2 (0.7–2.0) | >.99 | 0.7 (0.4–1.2) | .2 | |
| Background Conditions and Comorbidities Upon Admission | ||||||||||
| Partially or fully dependent in terms of functional status [37] | 91 (85.8) | 79 (73.8) | 48 (44.0) | 7.7 (4.0–15.0) | <.001 | 3.6 (2.0–6.4) | <.001 | 2.1 (1.1–4.3) | .03 | |
| Deteriorated consciousness level | 33 (31.1) | 38 (35.5) | 26 (23.9) | 1.4 (0.8–2.6) | .2 | 1.8 (1.0–3.2) | .06 | 0.8 (0.5–1.5) | .5 | |
| Ischemic heart disease | 40 (36.7) | 23 (21.1) | 39 (35.8) | 1.0 (0.6–1.8) | .9 | 0.5 (0.3–0.9) | .02 | 2.2 (1.2–4.0) | .01 | |
| Diabetes mellitus | 67 (61.5) | 57 (52.3) | 47 (43.1) | 2.1 (1.2–3.6) | .01 | 1.4 (0.8–2.5) | .17 | 1.5 (0.8–2.5) | .2 | |
| Chronic renal diseaseb | 34 (31.2) | 35 (32.1) | 20 (18.3) | 2.0 (1.1–3.8) | .03 | 2.1 (1.1–4.0) | .02 | 1.0 (0.5–1.7) | .9 | |
| Dementia | 32 (29.4) | 28 (25.7) | 14 (12.8) | 2.8 (1.4–5.7) | .003 | 2.3 (1.2–4.8) | .02 | 1.2 (0.7–2.2) | .5 | |
| Malignancy (active or in the past) | 18 (16.5) | 24 (22.0) | 21 (19.3) | 0.8 (0.4–1.7) | .6 | 1.2 (0.6–2.3) | .6 | 0.7 (0.4–1.4) | .3 | |
| Chronic skin ulcersc | 43 (39.4) | 10 (9.2) | 9 (8.3) | 7.2 (3.3–15.8) | <.001 | 1.1 (0.4–2.9) | .8 | 6.4 (3.0–13.8) | <.001 | |
| Charlson’s weighted index comorbidity [38], mean ± SD | 4.0 ± 2.3 | 3.2 ± 2.5 | 2.8 ± 2.4 | <.001 | .22 | .02 | ||||
| Overall immunosuppressiond | 22 (20.2) | 18 (16.5) | 23 (21.1) | 0.95 (0.5–1.8) | .9 | 0.7 (0.4–1.5) | .4 | 1.3 (0.6–2.5) | .5 | |
| Past MDROe in preceding 3 months before eventf | 63 (57.8) | 43 (39.4) | 2 (1.8) | 73.3 (17.2–312.2) | <.001 | 34.9 (8.2–148.7) | <.001 | 2.1 (1.2–3.6) | .01 | |
| Recent Exposures to Healthcare and to Antimicrobials | ||||||||||
| LCTF stay in the past 6 months | 32 (29.4) | 25 (22.9) | 25 (22.9) | 1.4 (0.8–2.6) | .3 | 1.0 (0.5–1.9) | >.99 | 1.4 (0.8–2.6) | .3 | |
| Hospitalized in the past 6 months | 70 (64.2) | 59 (54.1) | 46 (42.2) | 2.5 (1.4–4.2) | .001 | 1.6 (1.0–2.8) | .08 | 1.5 (0.9–2.6) | .11 | |
| ICU stay in the past 3 months | 54 (49.5) | 35 (32.1) | 28 (25.7) | 2.8 (1.6–5.0) | <.001 | 1.4 (0.8–2.5) | .3 | 2.0 (1.2–3.6) | .01 | |
| Invasive procedureg in the past 6 months before eventf | 84 (77.1) | 41 (37.6) | 74 (67.9) | 1.6 (0.9–2.9) | .1 | 0.3 (0.2–0.5) | <.001 | 5.6 (3.1–10.1) | <.001 | |
| Permanent devicesh for at least 48 hours before eventf,i | 84 (77.1) | 54 (49.5) | 74 (67.9) | 1.6 (0.9–2.9) | .1 | 0.5 (0.3–0.8) | .006 | 3.4 (1.9–6.1) | <.001 | |
| Exposures to antibioticsj in the 3 months before the eventf | Penicillins | 60 (55.0) | 26 (23.9) | 28 (25.7) | 3.5 (2.0–6.3) | <.001 | 0.9 (0.5–1.7) | .8 | 3.9 (2.2–7.0) | <.001 |
| Cephalosporins | 78 (71.6) | 43 (39.4) | 63 (57.8) | 1.8 (1.0–3.2) | .03 | 0.5 (0.3–0.8) | .007 | 3.9 (2.2–6.8) | <.001 | |
| Carbapenems | 50 (45.9) | 11 (10.1) | 7 (6.4) | 12.3 (5.3–29.0) | <.001 | 1.6 (0.6–4.4) | .3 | 7.5 (3.6–15.6) | <.001 | |
| Fluoroquinolones | 46 (42.2) | 16 (14.7) | 24 (22.2) | 2.6 (1.4–4.7) | .001 | 0.6 (0.3–1.2) | .2 | 4.2 (2.2–8.2) | <.001 | |
| Vancomycin | 34 (31.2) | 12 (11.0) | 12 (11.0) | 3.7 (1.8–7.6) | <.001 | 1.0 (0.4–2.3) | >.99 | 3.7 (1.8–7.6) | <.001 | |
| Metronidazole | 50 (45.0) | 6 (5.5) | 15 (13.8) | 5.1 (2. 6–9.9) | <.001 | 0.4 (0.1–1.0) | .04 | 14.0 (5.7–34.7) | <.001 | |
| Any antibiotic | 104 (95.4) | 61 (56.0) | 74 (67.9) | 9.8 (3.7–26.3) | <.001 | 0.6 (0.3–1.0) | .07 | 16.4 (6.2–43.3) | <.001 | |
| Conditions at the Date of Eventf | ||||||||||
| Mechanically ventilated | 38 (34.9) | 4 (3.7) | 18 (16.5) | 2.7 (1.4–5.1) | .002 | 0.2 (0.1–0.6) | .002 | 14.0 (4.8–41.1) | <.001 | |
| Rapidly fatal McCabe score [39] | 44 (41.1) | 27 (24.8) | 19 (17.4) | 3.2 (1.7–6.0) | <.001 | 1.6 (0.8–3.0) | .2 | 2.1 (1.2–3.7) | .01 | |
| Outcomes | ||||||||||
| In-hospital mortality | 37 (33.9) | 26 (23.9) | 19 (17.4) | 2.4 (1.3–4.6) | .005 | 1.5 (0.8–2.9) | .2 | 1.6 (0.9–3.0) | .1 | |
| 30-day mortality | 45 (41.3) | 35 (32.1) | 22 (20.2) | 2.8 (1.5–5.1) | .001 | 1.9 (1.0–3.5) | .04 | 1.5 (0.9–2.6) | .2 | |
| 90-day mortality | 52 (47.7) | 46 (42.2) | 28 (25.7) | 2.6 (1.5–4.7) | .001 | 2.1 (1.2–3.7) | .01 | 1.2 (0.7–2.13) | .4 | |
| Among patients who survived the index hospitalization | Length of stay from culture to dischargek, median )IQR(, n = 240 | 15 (6,32) | 5 (2,14) | 18 (10,29) | .22 | <.001 | <.001 | |||
| Functional deterioration [37], n = 238 | 34 (50.7) | 10 (12.3) | 50 (55.6) | 0.8 (0.4–1.5) | .5 | 0.1 (0.1–0.3) | <.001 | 7.3 (3.2–16.6) | <.001 | |
| Discharged to LTCF after being admitted from home, n = 220 | 28 (50.0) | 17 (22.7) | 42 (47.2) | 1.1 (0.6–2.2) | .7 | 0.3 (0.2–0.6) | .001 | 3.4 (1.6–7.2) | .001 | |
| Additional hospitalizations in the following 6 months, n = 239 | 36 (54.5) | 46 (55.4) | 38 (42.2) | 1.6 (0.9–3.1) | .1 | 1.7 (0.9–3.1) | .08 | 1.0 (0.5–1.8) | .9 | |
| An invasive procedureg in the following 3 months, n = 236 | 16 (24.6) | 23 (28.4) | 13 (14.4) | 1.9 (0.9–4.4) | .1 | 2.3 (1.1–5.0) | .02 | 0.8 (0.4–1.7) | .6 | |
| . | . | . | . | . | Non-CP-CRE vs Uninfected . | Susceptible Enterobacteriaceae vs Uninfected . | CRE vs Susceptible Enterobacteriaceae . | |||
|---|---|---|---|---|---|---|---|---|---|---|
| Parameter . | . | Non-CP-CRE No. (%)a . | Susceptible Enterobacteriaceae No. (%)a . | Uninfected Controls No. (%)a . | OR (95% CI) . | P Value . | OR (95% CI) . | P Value . | OR (95% CI) . | P Value . |
| Demographics | ||||||||||
| Age (years), median (IQR) | 76 (64–84) | 75 (63–84) | 76 (64–91) | .9 | .6 | .6 | ||||
| Age group | Pediatrics (<16 years) | 2 (1.8) | 2 (1.8) | 2 (1.8) | - | - | - | - | - | - |
| Elderly (>65 years) | 80 (73.4) | 80 (73.4) | 80 (73.4) | - | - | - | - | - | - | |
| Female gender | 49 (45.0) | 58 (53.2) | 53 (48.6) | 0.9 (0.5–1.5) | .6 | 1.2 (0.7–2.0) | >.99 | 0.7 (0.4–1.2) | .2 | |
| Background Conditions and Comorbidities Upon Admission | ||||||||||
| Partially or fully dependent in terms of functional status [37] | 91 (85.8) | 79 (73.8) | 48 (44.0) | 7.7 (4.0–15.0) | <.001 | 3.6 (2.0–6.4) | <.001 | 2.1 (1.1–4.3) | .03 | |
| Deteriorated consciousness level | 33 (31.1) | 38 (35.5) | 26 (23.9) | 1.4 (0.8–2.6) | .2 | 1.8 (1.0–3.2) | .06 | 0.8 (0.5–1.5) | .5 | |
| Ischemic heart disease | 40 (36.7) | 23 (21.1) | 39 (35.8) | 1.0 (0.6–1.8) | .9 | 0.5 (0.3–0.9) | .02 | 2.2 (1.2–4.0) | .01 | |
| Diabetes mellitus | 67 (61.5) | 57 (52.3) | 47 (43.1) | 2.1 (1.2–3.6) | .01 | 1.4 (0.8–2.5) | .17 | 1.5 (0.8–2.5) | .2 | |
| Chronic renal diseaseb | 34 (31.2) | 35 (32.1) | 20 (18.3) | 2.0 (1.1–3.8) | .03 | 2.1 (1.1–4.0) | .02 | 1.0 (0.5–1.7) | .9 | |
| Dementia | 32 (29.4) | 28 (25.7) | 14 (12.8) | 2.8 (1.4–5.7) | .003 | 2.3 (1.2–4.8) | .02 | 1.2 (0.7–2.2) | .5 | |
| Malignancy (active or in the past) | 18 (16.5) | 24 (22.0) | 21 (19.3) | 0.8 (0.4–1.7) | .6 | 1.2 (0.6–2.3) | .6 | 0.7 (0.4–1.4) | .3 | |
| Chronic skin ulcersc | 43 (39.4) | 10 (9.2) | 9 (8.3) | 7.2 (3.3–15.8) | <.001 | 1.1 (0.4–2.9) | .8 | 6.4 (3.0–13.8) | <.001 | |
| Charlson’s weighted index comorbidity [38], mean ± SD | 4.0 ± 2.3 | 3.2 ± 2.5 | 2.8 ± 2.4 | <.001 | .22 | .02 | ||||
| Overall immunosuppressiond | 22 (20.2) | 18 (16.5) | 23 (21.1) | 0.95 (0.5–1.8) | .9 | 0.7 (0.4–1.5) | .4 | 1.3 (0.6–2.5) | .5 | |
| Past MDROe in preceding 3 months before eventf | 63 (57.8) | 43 (39.4) | 2 (1.8) | 73.3 (17.2–312.2) | <.001 | 34.9 (8.2–148.7) | <.001 | 2.1 (1.2–3.6) | .01 | |
| Recent Exposures to Healthcare and to Antimicrobials | ||||||||||
| LCTF stay in the past 6 months | 32 (29.4) | 25 (22.9) | 25 (22.9) | 1.4 (0.8–2.6) | .3 | 1.0 (0.5–1.9) | >.99 | 1.4 (0.8–2.6) | .3 | |
| Hospitalized in the past 6 months | 70 (64.2) | 59 (54.1) | 46 (42.2) | 2.5 (1.4–4.2) | .001 | 1.6 (1.0–2.8) | .08 | 1.5 (0.9–2.6) | .11 | |
| ICU stay in the past 3 months | 54 (49.5) | 35 (32.1) | 28 (25.7) | 2.8 (1.6–5.0) | <.001 | 1.4 (0.8–2.5) | .3 | 2.0 (1.2–3.6) | .01 | |
| Invasive procedureg in the past 6 months before eventf | 84 (77.1) | 41 (37.6) | 74 (67.9) | 1.6 (0.9–2.9) | .1 | 0.3 (0.2–0.5) | <.001 | 5.6 (3.1–10.1) | <.001 | |
| Permanent devicesh for at least 48 hours before eventf,i | 84 (77.1) | 54 (49.5) | 74 (67.9) | 1.6 (0.9–2.9) | .1 | 0.5 (0.3–0.8) | .006 | 3.4 (1.9–6.1) | <.001 | |
| Exposures to antibioticsj in the 3 months before the eventf | Penicillins | 60 (55.0) | 26 (23.9) | 28 (25.7) | 3.5 (2.0–6.3) | <.001 | 0.9 (0.5–1.7) | .8 | 3.9 (2.2–7.0) | <.001 |
| Cephalosporins | 78 (71.6) | 43 (39.4) | 63 (57.8) | 1.8 (1.0–3.2) | .03 | 0.5 (0.3–0.8) | .007 | 3.9 (2.2–6.8) | <.001 | |
| Carbapenems | 50 (45.9) | 11 (10.1) | 7 (6.4) | 12.3 (5.3–29.0) | <.001 | 1.6 (0.6–4.4) | .3 | 7.5 (3.6–15.6) | <.001 | |
| Fluoroquinolones | 46 (42.2) | 16 (14.7) | 24 (22.2) | 2.6 (1.4–4.7) | .001 | 0.6 (0.3–1.2) | .2 | 4.2 (2.2–8.2) | <.001 | |
| Vancomycin | 34 (31.2) | 12 (11.0) | 12 (11.0) | 3.7 (1.8–7.6) | <.001 | 1.0 (0.4–2.3) | >.99 | 3.7 (1.8–7.6) | <.001 | |
| Metronidazole | 50 (45.0) | 6 (5.5) | 15 (13.8) | 5.1 (2. 6–9.9) | <.001 | 0.4 (0.1–1.0) | .04 | 14.0 (5.7–34.7) | <.001 | |
| Any antibiotic | 104 (95.4) | 61 (56.0) | 74 (67.9) | 9.8 (3.7–26.3) | <.001 | 0.6 (0.3–1.0) | .07 | 16.4 (6.2–43.3) | <.001 | |
| Conditions at the Date of Eventf | ||||||||||
| Mechanically ventilated | 38 (34.9) | 4 (3.7) | 18 (16.5) | 2.7 (1.4–5.1) | .002 | 0.2 (0.1–0.6) | .002 | 14.0 (4.8–41.1) | <.001 | |
| Rapidly fatal McCabe score [39] | 44 (41.1) | 27 (24.8) | 19 (17.4) | 3.2 (1.7–6.0) | <.001 | 1.6 (0.8–3.0) | .2 | 2.1 (1.2–3.7) | .01 | |
| Outcomes | ||||||||||
| In-hospital mortality | 37 (33.9) | 26 (23.9) | 19 (17.4) | 2.4 (1.3–4.6) | .005 | 1.5 (0.8–2.9) | .2 | 1.6 (0.9–3.0) | .1 | |
| 30-day mortality | 45 (41.3) | 35 (32.1) | 22 (20.2) | 2.8 (1.5–5.1) | .001 | 1.9 (1.0–3.5) | .04 | 1.5 (0.9–2.6) | .2 | |
| 90-day mortality | 52 (47.7) | 46 (42.2) | 28 (25.7) | 2.6 (1.5–4.7) | .001 | 2.1 (1.2–3.7) | .01 | 1.2 (0.7–2.13) | .4 | |
| Among patients who survived the index hospitalization | Length of stay from culture to dischargek, median )IQR(, n = 240 | 15 (6,32) | 5 (2,14) | 18 (10,29) | .22 | <.001 | <.001 | |||
| Functional deterioration [37], n = 238 | 34 (50.7) | 10 (12.3) | 50 (55.6) | 0.8 (0.4–1.5) | .5 | 0.1 (0.1–0.3) | <.001 | 7.3 (3.2–16.6) | <.001 | |
| Discharged to LTCF after being admitted from home, n = 220 | 28 (50.0) | 17 (22.7) | 42 (47.2) | 1.1 (0.6–2.2) | .7 | 0.3 (0.2–0.6) | .001 | 3.4 (1.6–7.2) | .001 | |
| Additional hospitalizations in the following 6 months, n = 239 | 36 (54.5) | 46 (55.4) | 38 (42.2) | 1.6 (0.9–3.1) | .1 | 1.7 (0.9–3.1) | .08 | 1.0 (0.5–1.8) | .9 | |
| An invasive procedureg in the following 3 months, n = 236 | 16 (24.6) | 23 (28.4) | 13 (14.4) | 1.9 (0.9–4.4) | .1 | 2.3 (1.1–5.0) | .02 | 0.8 (0.4–1.7) | .6 | |
Abbreviations: CI, confidence interval; CP, carbapenemase producing; CRE, carbapenem-resistant Enterobacteriaceae; CVA, cerebrovascular accident; ICU, intensive care unit; IQR, interquartile ratio; LTCF, long-term care facility; MDRO, multidrug-resistant organism; OR, odds ratio; SD, standard deviation.
NOTE: Significant associations are highlighted in bold.
aValid percentage: count divided by the total number of valid (ie, nonmissing) observations.
bSerum creatinine over 1.5 mg/dL or if patient was regularly undergoing hemodialysis or peritoneal dialysis.
cLower limb diabetic foot wounds, decubitus ulcers, dwelling wound surrounding PEG insertion, surgical-site wounds, surrounding catheters.
dImmunosuppression includes any of the following: neutropenia at culture date (<500 neutrophils/mm), exposure to glucocorticoids in the previous month, chemotherapy in the previous 3 months, radiotherapy, posttransplantation of any kind, or any immunomodulator.
eIncludes methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, extended-spectrum beta lactamase-producing Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa.
fEvent was defined as bacterial isolation for the patients who acquired non-CP-CRE or susceptible Enterobacteriaceae and as patients’ discharge date for uninfected patients.
gAny type of invasive procedure, including endoscopies, any percutaneous intervention, biopsies, and any type of surgery.
hTracheotomies, permanent central venous lines, permanent urinary catheters, orthopedic external fixators, gastrostomies, drains. Not included: internal stents, prosthetic heart valve, and prosthetic joints.
iFor uninfected patients, we considered patients to have had a permeant device if it was placed for more than 48 hours during their entire hospitalization.
jPatient received an antibiotic course of at least 48 hours.
kFor uninfected patients, we calculated the total length of stay.
Selected Bivariable Analyses Comparing Risk Factors and Outcomes of Patients With Non-CP-CRE, Shamir (Assaf Harofeh) Medical Center (November 2014–December 2016), (n = 109 in Each Group)
| . | . | . | . | . | Non-CP-CRE vs Uninfected . | Susceptible Enterobacteriaceae vs Uninfected . | CRE vs Susceptible Enterobacteriaceae . | |||
|---|---|---|---|---|---|---|---|---|---|---|
| Parameter . | . | Non-CP-CRE No. (%)a . | Susceptible Enterobacteriaceae No. (%)a . | Uninfected Controls No. (%)a . | OR (95% CI) . | P Value . | OR (95% CI) . | P Value . | OR (95% CI) . | P Value . |
| Demographics | ||||||||||
| Age (years), median (IQR) | 76 (64–84) | 75 (63–84) | 76 (64–91) | .9 | .6 | .6 | ||||
| Age group | Pediatrics (<16 years) | 2 (1.8) | 2 (1.8) | 2 (1.8) | - | - | - | - | - | - |
| Elderly (>65 years) | 80 (73.4) | 80 (73.4) | 80 (73.4) | - | - | - | - | - | - | |
| Female gender | 49 (45.0) | 58 (53.2) | 53 (48.6) | 0.9 (0.5–1.5) | .6 | 1.2 (0.7–2.0) | >.99 | 0.7 (0.4–1.2) | .2 | |
| Background Conditions and Comorbidities Upon Admission | ||||||||||
| Partially or fully dependent in terms of functional status [37] | 91 (85.8) | 79 (73.8) | 48 (44.0) | 7.7 (4.0–15.0) | <.001 | 3.6 (2.0–6.4) | <.001 | 2.1 (1.1–4.3) | .03 | |
| Deteriorated consciousness level | 33 (31.1) | 38 (35.5) | 26 (23.9) | 1.4 (0.8–2.6) | .2 | 1.8 (1.0–3.2) | .06 | 0.8 (0.5–1.5) | .5 | |
| Ischemic heart disease | 40 (36.7) | 23 (21.1) | 39 (35.8) | 1.0 (0.6–1.8) | .9 | 0.5 (0.3–0.9) | .02 | 2.2 (1.2–4.0) | .01 | |
| Diabetes mellitus | 67 (61.5) | 57 (52.3) | 47 (43.1) | 2.1 (1.2–3.6) | .01 | 1.4 (0.8–2.5) | .17 | 1.5 (0.8–2.5) | .2 | |
| Chronic renal diseaseb | 34 (31.2) | 35 (32.1) | 20 (18.3) | 2.0 (1.1–3.8) | .03 | 2.1 (1.1–4.0) | .02 | 1.0 (0.5–1.7) | .9 | |
| Dementia | 32 (29.4) | 28 (25.7) | 14 (12.8) | 2.8 (1.4–5.7) | .003 | 2.3 (1.2–4.8) | .02 | 1.2 (0.7–2.2) | .5 | |
| Malignancy (active or in the past) | 18 (16.5) | 24 (22.0) | 21 (19.3) | 0.8 (0.4–1.7) | .6 | 1.2 (0.6–2.3) | .6 | 0.7 (0.4–1.4) | .3 | |
| Chronic skin ulcersc | 43 (39.4) | 10 (9.2) | 9 (8.3) | 7.2 (3.3–15.8) | <.001 | 1.1 (0.4–2.9) | .8 | 6.4 (3.0–13.8) | <.001 | |
| Charlson’s weighted index comorbidity [38], mean ± SD | 4.0 ± 2.3 | 3.2 ± 2.5 | 2.8 ± 2.4 | <.001 | .22 | .02 | ||||
| Overall immunosuppressiond | 22 (20.2) | 18 (16.5) | 23 (21.1) | 0.95 (0.5–1.8) | .9 | 0.7 (0.4–1.5) | .4 | 1.3 (0.6–2.5) | .5 | |
| Past MDROe in preceding 3 months before eventf | 63 (57.8) | 43 (39.4) | 2 (1.8) | 73.3 (17.2–312.2) | <.001 | 34.9 (8.2–148.7) | <.001 | 2.1 (1.2–3.6) | .01 | |
| Recent Exposures to Healthcare and to Antimicrobials | ||||||||||
| LCTF stay in the past 6 months | 32 (29.4) | 25 (22.9) | 25 (22.9) | 1.4 (0.8–2.6) | .3 | 1.0 (0.5–1.9) | >.99 | 1.4 (0.8–2.6) | .3 | |
| Hospitalized in the past 6 months | 70 (64.2) | 59 (54.1) | 46 (42.2) | 2.5 (1.4–4.2) | .001 | 1.6 (1.0–2.8) | .08 | 1.5 (0.9–2.6) | .11 | |
| ICU stay in the past 3 months | 54 (49.5) | 35 (32.1) | 28 (25.7) | 2.8 (1.6–5.0) | <.001 | 1.4 (0.8–2.5) | .3 | 2.0 (1.2–3.6) | .01 | |
| Invasive procedureg in the past 6 months before eventf | 84 (77.1) | 41 (37.6) | 74 (67.9) | 1.6 (0.9–2.9) | .1 | 0.3 (0.2–0.5) | <.001 | 5.6 (3.1–10.1) | <.001 | |
| Permanent devicesh for at least 48 hours before eventf,i | 84 (77.1) | 54 (49.5) | 74 (67.9) | 1.6 (0.9–2.9) | .1 | 0.5 (0.3–0.8) | .006 | 3.4 (1.9–6.1) | <.001 | |
| Exposures to antibioticsj in the 3 months before the eventf | Penicillins | 60 (55.0) | 26 (23.9) | 28 (25.7) | 3.5 (2.0–6.3) | <.001 | 0.9 (0.5–1.7) | .8 | 3.9 (2.2–7.0) | <.001 |
| Cephalosporins | 78 (71.6) | 43 (39.4) | 63 (57.8) | 1.8 (1.0–3.2) | .03 | 0.5 (0.3–0.8) | .007 | 3.9 (2.2–6.8) | <.001 | |
| Carbapenems | 50 (45.9) | 11 (10.1) | 7 (6.4) | 12.3 (5.3–29.0) | <.001 | 1.6 (0.6–4.4) | .3 | 7.5 (3.6–15.6) | <.001 | |
| Fluoroquinolones | 46 (42.2) | 16 (14.7) | 24 (22.2) | 2.6 (1.4–4.7) | .001 | 0.6 (0.3–1.2) | .2 | 4.2 (2.2–8.2) | <.001 | |
| Vancomycin | 34 (31.2) | 12 (11.0) | 12 (11.0) | 3.7 (1.8–7.6) | <.001 | 1.0 (0.4–2.3) | >.99 | 3.7 (1.8–7.6) | <.001 | |
| Metronidazole | 50 (45.0) | 6 (5.5) | 15 (13.8) | 5.1 (2. 6–9.9) | <.001 | 0.4 (0.1–1.0) | .04 | 14.0 (5.7–34.7) | <.001 | |
| Any antibiotic | 104 (95.4) | 61 (56.0) | 74 (67.9) | 9.8 (3.7–26.3) | <.001 | 0.6 (0.3–1.0) | .07 | 16.4 (6.2–43.3) | <.001 | |
| Conditions at the Date of Eventf | ||||||||||
| Mechanically ventilated | 38 (34.9) | 4 (3.7) | 18 (16.5) | 2.7 (1.4–5.1) | .002 | 0.2 (0.1–0.6) | .002 | 14.0 (4.8–41.1) | <.001 | |
| Rapidly fatal McCabe score [39] | 44 (41.1) | 27 (24.8) | 19 (17.4) | 3.2 (1.7–6.0) | <.001 | 1.6 (0.8–3.0) | .2 | 2.1 (1.2–3.7) | .01 | |
| Outcomes | ||||||||||
| In-hospital mortality | 37 (33.9) | 26 (23.9) | 19 (17.4) | 2.4 (1.3–4.6) | .005 | 1.5 (0.8–2.9) | .2 | 1.6 (0.9–3.0) | .1 | |
| 30-day mortality | 45 (41.3) | 35 (32.1) | 22 (20.2) | 2.8 (1.5–5.1) | .001 | 1.9 (1.0–3.5) | .04 | 1.5 (0.9–2.6) | .2 | |
| 90-day mortality | 52 (47.7) | 46 (42.2) | 28 (25.7) | 2.6 (1.5–4.7) | .001 | 2.1 (1.2–3.7) | .01 | 1.2 (0.7–2.13) | .4 | |
| Among patients who survived the index hospitalization | Length of stay from culture to dischargek, median )IQR(, n = 240 | 15 (6,32) | 5 (2,14) | 18 (10,29) | .22 | <.001 | <.001 | |||
| Functional deterioration [37], n = 238 | 34 (50.7) | 10 (12.3) | 50 (55.6) | 0.8 (0.4–1.5) | .5 | 0.1 (0.1–0.3) | <.001 | 7.3 (3.2–16.6) | <.001 | |
| Discharged to LTCF after being admitted from home, n = 220 | 28 (50.0) | 17 (22.7) | 42 (47.2) | 1.1 (0.6–2.2) | .7 | 0.3 (0.2–0.6) | .001 | 3.4 (1.6–7.2) | .001 | |
| Additional hospitalizations in the following 6 months, n = 239 | 36 (54.5) | 46 (55.4) | 38 (42.2) | 1.6 (0.9–3.1) | .1 | 1.7 (0.9–3.1) | .08 | 1.0 (0.5–1.8) | .9 | |
| An invasive procedureg in the following 3 months, n = 236 | 16 (24.6) | 23 (28.4) | 13 (14.4) | 1.9 (0.9–4.4) | .1 | 2.3 (1.1–5.0) | .02 | 0.8 (0.4–1.7) | .6 | |
| . | . | . | . | . | Non-CP-CRE vs Uninfected . | Susceptible Enterobacteriaceae vs Uninfected . | CRE vs Susceptible Enterobacteriaceae . | |||
|---|---|---|---|---|---|---|---|---|---|---|
| Parameter . | . | Non-CP-CRE No. (%)a . | Susceptible Enterobacteriaceae No. (%)a . | Uninfected Controls No. (%)a . | OR (95% CI) . | P Value . | OR (95% CI) . | P Value . | OR (95% CI) . | P Value . |
| Demographics | ||||||||||
| Age (years), median (IQR) | 76 (64–84) | 75 (63–84) | 76 (64–91) | .9 | .6 | .6 | ||||
| Age group | Pediatrics (<16 years) | 2 (1.8) | 2 (1.8) | 2 (1.8) | - | - | - | - | - | - |
| Elderly (>65 years) | 80 (73.4) | 80 (73.4) | 80 (73.4) | - | - | - | - | - | - | |
| Female gender | 49 (45.0) | 58 (53.2) | 53 (48.6) | 0.9 (0.5–1.5) | .6 | 1.2 (0.7–2.0) | >.99 | 0.7 (0.4–1.2) | .2 | |
| Background Conditions and Comorbidities Upon Admission | ||||||||||
| Partially or fully dependent in terms of functional status [37] | 91 (85.8) | 79 (73.8) | 48 (44.0) | 7.7 (4.0–15.0) | <.001 | 3.6 (2.0–6.4) | <.001 | 2.1 (1.1–4.3) | .03 | |
| Deteriorated consciousness level | 33 (31.1) | 38 (35.5) | 26 (23.9) | 1.4 (0.8–2.6) | .2 | 1.8 (1.0–3.2) | .06 | 0.8 (0.5–1.5) | .5 | |
| Ischemic heart disease | 40 (36.7) | 23 (21.1) | 39 (35.8) | 1.0 (0.6–1.8) | .9 | 0.5 (0.3–0.9) | .02 | 2.2 (1.2–4.0) | .01 | |
| Diabetes mellitus | 67 (61.5) | 57 (52.3) | 47 (43.1) | 2.1 (1.2–3.6) | .01 | 1.4 (0.8–2.5) | .17 | 1.5 (0.8–2.5) | .2 | |
| Chronic renal diseaseb | 34 (31.2) | 35 (32.1) | 20 (18.3) | 2.0 (1.1–3.8) | .03 | 2.1 (1.1–4.0) | .02 | 1.0 (0.5–1.7) | .9 | |
| Dementia | 32 (29.4) | 28 (25.7) | 14 (12.8) | 2.8 (1.4–5.7) | .003 | 2.3 (1.2–4.8) | .02 | 1.2 (0.7–2.2) | .5 | |
| Malignancy (active or in the past) | 18 (16.5) | 24 (22.0) | 21 (19.3) | 0.8 (0.4–1.7) | .6 | 1.2 (0.6–2.3) | .6 | 0.7 (0.4–1.4) | .3 | |
| Chronic skin ulcersc | 43 (39.4) | 10 (9.2) | 9 (8.3) | 7.2 (3.3–15.8) | <.001 | 1.1 (0.4–2.9) | .8 | 6.4 (3.0–13.8) | <.001 | |
| Charlson’s weighted index comorbidity [38], mean ± SD | 4.0 ± 2.3 | 3.2 ± 2.5 | 2.8 ± 2.4 | <.001 | .22 | .02 | ||||
| Overall immunosuppressiond | 22 (20.2) | 18 (16.5) | 23 (21.1) | 0.95 (0.5–1.8) | .9 | 0.7 (0.4–1.5) | .4 | 1.3 (0.6–2.5) | .5 | |
| Past MDROe in preceding 3 months before eventf | 63 (57.8) | 43 (39.4) | 2 (1.8) | 73.3 (17.2–312.2) | <.001 | 34.9 (8.2–148.7) | <.001 | 2.1 (1.2–3.6) | .01 | |
| Recent Exposures to Healthcare and to Antimicrobials | ||||||||||
| LCTF stay in the past 6 months | 32 (29.4) | 25 (22.9) | 25 (22.9) | 1.4 (0.8–2.6) | .3 | 1.0 (0.5–1.9) | >.99 | 1.4 (0.8–2.6) | .3 | |
| Hospitalized in the past 6 months | 70 (64.2) | 59 (54.1) | 46 (42.2) | 2.5 (1.4–4.2) | .001 | 1.6 (1.0–2.8) | .08 | 1.5 (0.9–2.6) | .11 | |
| ICU stay in the past 3 months | 54 (49.5) | 35 (32.1) | 28 (25.7) | 2.8 (1.6–5.0) | <.001 | 1.4 (0.8–2.5) | .3 | 2.0 (1.2–3.6) | .01 | |
| Invasive procedureg in the past 6 months before eventf | 84 (77.1) | 41 (37.6) | 74 (67.9) | 1.6 (0.9–2.9) | .1 | 0.3 (0.2–0.5) | <.001 | 5.6 (3.1–10.1) | <.001 | |
| Permanent devicesh for at least 48 hours before eventf,i | 84 (77.1) | 54 (49.5) | 74 (67.9) | 1.6 (0.9–2.9) | .1 | 0.5 (0.3–0.8) | .006 | 3.4 (1.9–6.1) | <.001 | |
| Exposures to antibioticsj in the 3 months before the eventf | Penicillins | 60 (55.0) | 26 (23.9) | 28 (25.7) | 3.5 (2.0–6.3) | <.001 | 0.9 (0.5–1.7) | .8 | 3.9 (2.2–7.0) | <.001 |
| Cephalosporins | 78 (71.6) | 43 (39.4) | 63 (57.8) | 1.8 (1.0–3.2) | .03 | 0.5 (0.3–0.8) | .007 | 3.9 (2.2–6.8) | <.001 | |
| Carbapenems | 50 (45.9) | 11 (10.1) | 7 (6.4) | 12.3 (5.3–29.0) | <.001 | 1.6 (0.6–4.4) | .3 | 7.5 (3.6–15.6) | <.001 | |
| Fluoroquinolones | 46 (42.2) | 16 (14.7) | 24 (22.2) | 2.6 (1.4–4.7) | .001 | 0.6 (0.3–1.2) | .2 | 4.2 (2.2–8.2) | <.001 | |
| Vancomycin | 34 (31.2) | 12 (11.0) | 12 (11.0) | 3.7 (1.8–7.6) | <.001 | 1.0 (0.4–2.3) | >.99 | 3.7 (1.8–7.6) | <.001 | |
| Metronidazole | 50 (45.0) | 6 (5.5) | 15 (13.8) | 5.1 (2. 6–9.9) | <.001 | 0.4 (0.1–1.0) | .04 | 14.0 (5.7–34.7) | <.001 | |
| Any antibiotic | 104 (95.4) | 61 (56.0) | 74 (67.9) | 9.8 (3.7–26.3) | <.001 | 0.6 (0.3–1.0) | .07 | 16.4 (6.2–43.3) | <.001 | |
| Conditions at the Date of Eventf | ||||||||||
| Mechanically ventilated | 38 (34.9) | 4 (3.7) | 18 (16.5) | 2.7 (1.4–5.1) | .002 | 0.2 (0.1–0.6) | .002 | 14.0 (4.8–41.1) | <.001 | |
| Rapidly fatal McCabe score [39] | 44 (41.1) | 27 (24.8) | 19 (17.4) | 3.2 (1.7–6.0) | <.001 | 1.6 (0.8–3.0) | .2 | 2.1 (1.2–3.7) | .01 | |
| Outcomes | ||||||||||
| In-hospital mortality | 37 (33.9) | 26 (23.9) | 19 (17.4) | 2.4 (1.3–4.6) | .005 | 1.5 (0.8–2.9) | .2 | 1.6 (0.9–3.0) | .1 | |
| 30-day mortality | 45 (41.3) | 35 (32.1) | 22 (20.2) | 2.8 (1.5–5.1) | .001 | 1.9 (1.0–3.5) | .04 | 1.5 (0.9–2.6) | .2 | |
| 90-day mortality | 52 (47.7) | 46 (42.2) | 28 (25.7) | 2.6 (1.5–4.7) | .001 | 2.1 (1.2–3.7) | .01 | 1.2 (0.7–2.13) | .4 | |
| Among patients who survived the index hospitalization | Length of stay from culture to dischargek, median )IQR(, n = 240 | 15 (6,32) | 5 (2,14) | 18 (10,29) | .22 | <.001 | <.001 | |||
| Functional deterioration [37], n = 238 | 34 (50.7) | 10 (12.3) | 50 (55.6) | 0.8 (0.4–1.5) | .5 | 0.1 (0.1–0.3) | <.001 | 7.3 (3.2–16.6) | <.001 | |
| Discharged to LTCF after being admitted from home, n = 220 | 28 (50.0) | 17 (22.7) | 42 (47.2) | 1.1 (0.6–2.2) | .7 | 0.3 (0.2–0.6) | .001 | 3.4 (1.6–7.2) | .001 | |
| Additional hospitalizations in the following 6 months, n = 239 | 36 (54.5) | 46 (55.4) | 38 (42.2) | 1.6 (0.9–3.1) | .1 | 1.7 (0.9–3.1) | .08 | 1.0 (0.5–1.8) | .9 | |
| An invasive procedureg in the following 3 months, n = 236 | 16 (24.6) | 23 (28.4) | 13 (14.4) | 1.9 (0.9–4.4) | .1 | 2.3 (1.1–5.0) | .02 | 0.8 (0.4–1.7) | .6 | |
Abbreviations: CI, confidence interval; CP, carbapenemase producing; CRE, carbapenem-resistant Enterobacteriaceae; CVA, cerebrovascular accident; ICU, intensive care unit; IQR, interquartile ratio; LTCF, long-term care facility; MDRO, multidrug-resistant organism; OR, odds ratio; SD, standard deviation.
NOTE: Significant associations are highlighted in bold.
aValid percentage: count divided by the total number of valid (ie, nonmissing) observations.
bSerum creatinine over 1.5 mg/dL or if patient was regularly undergoing hemodialysis or peritoneal dialysis.
cLower limb diabetic foot wounds, decubitus ulcers, dwelling wound surrounding PEG insertion, surgical-site wounds, surrounding catheters.
dImmunosuppression includes any of the following: neutropenia at culture date (<500 neutrophils/mm), exposure to glucocorticoids in the previous month, chemotherapy in the previous 3 months, radiotherapy, posttransplantation of any kind, or any immunomodulator.
eIncludes methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, extended-spectrum beta lactamase-producing Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa.
fEvent was defined as bacterial isolation for the patients who acquired non-CP-CRE or susceptible Enterobacteriaceae and as patients’ discharge date for uninfected patients.
gAny type of invasive procedure, including endoscopies, any percutaneous intervention, biopsies, and any type of surgery.
hTracheotomies, permanent central venous lines, permanent urinary catheters, orthopedic external fixators, gastrostomies, drains. Not included: internal stents, prosthetic heart valve, and prosthetic joints.
iFor uninfected patients, we considered patients to have had a permeant device if it was placed for more than 48 hours during their entire hospitalization.
jPatient received an antibiotic course of at least 48 hours.
kFor uninfected patients, we calculated the total length of stay.
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