Clinical and molecular characteristics and risk factors for patients acquiring carbapenemase-producing and noncarbapenemase-producing carbapenemnonsusceptible-Enterobacterales bacteremia

Abstract

Abstract Background/purpose: Carbapenem-nonsusceptible Enterobacterales (CNSE) are a growing global threat. Carbapenemases are often produced by plasmids, which allow rapid transmission. This study aimed to investigate (1) the bacterial type (2) resistant genes (3) antimicrobial susceptibility and (4) risk factors for acquisition of carbapenemase-producing carbapenem-nonsusceptible Enterobacterales (CP-CNSE) and non-carbapenemase-producing carbapenem-nonsusceptible Enterobacterales (non-CP-CNSE) bacteremia. Methods: There were a total of 113 isolates of Enterobacterales from 2013 to 2018. After excluding nonblood isolates and including only one sample from each patient, 99 isolates were analyzed and the medical charts of these patients were reviewed. Carbapenemase genes, blactamase genes and antimicrobial susceptibility of the isolates were determined. Multilocussequence typing (MLST) was performed on CP-CNSE isolates. Results: CP-CNSE carried more blaSHV (P Z 0.004) and were more resistant to imipenem than non-CP-CNSE (P < 0.001). In the univariate analyses, we found that CP-CNSE bloodstream infection was associated with patient <65 years of age (odds ratio, 3.90; 95% confidence interval [CI], 1.16 to 13.10; P Z 0.027), mechanical ventilation at the time of bloodstream infection (BSI) (odds ratio, 3.85; 95% CI, 1.16e12.78; P Z 0.028) and exposure to piperacillin/tazobactam (odds ratio, 3.96; 95% CI, 1.09e14.38; P Z 0.037). However, on multivariate analyses, no independent predictor for CP-CNSE was identified in this study. Conclusion: CP-CNSE carried more blaSHV and were more resistant to imipenem when compared to non-CP-CNSE. No independent predictor for CP-CNSE was identified after multivariate analysis. This is the first study conducted in Taiwan comparing risk factors between CP-CNSE and non-CP-CNSE from both clinical and molecular aspects.