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Risk of invasive MDRO infection in MDRO-colonized patients
Ali M Alshubaily1, Aeshah S Alosaimi2, Bushra I Alhothli3
1Pediatric Infectious Diseases Section, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
Objective:
In this study, we aim to estimate the risk of developing clinical multidrug-resistant organism (MDRO) infection with carbapenem-resistant Enterobacterales (CRE), methicillin-resistant Staphylococcus aureus (MRSA), or vancomycin-resistant enterococci (VRE) in colonized patients compared with non-colonized admitted to high-risk areas with a main focus on CRE colonization/infection.
Design And Setting:
Retrospective cohort study conducted at a tertiary care facility.
Methods:
This study included patients enrolled in active surveillance testing (AST) for CRE, MRSA, or VRE during the year 2021. Development of relevant invasive infection within 365 days of the AST result was collected as the primary outcome. The association between MDRO colonization and infection was calculated using the risk ratio. The prevalence of CRE organisms and carbapenemase genes is presented.
Results:
A total of 19,134 ASTs were included in the analysis (4,919 CRE AST, 8,303 MRSA AST, and 5,912 VRE AST). Patient demographics were similar between colonized and non-colonized groups. Colonization was associated with an increased risk of infection in the 3 cohorts (CRE, MRSA, and VRE), with risk ratios reported as 4.6, 8.2, and 22, respectively. Most patients (88%) develop CRE infection with the same colonizing carbapenemase gene. Oxa-48/NDM Klebsiella pneumoniae was the most common organism detected in CRE infection.
Conclusions:
The study demonstrated that colonization with CRE, MRSA, or VRE is a risk factor for developing infections caused by the respective bacteria. The high percentage of match between carbapenemase genes detected in colonization and infection indicates that screening results might be used to inform infection management and treatment.
Insights
Colonization with multidrug-resistant organisms (MDROs) like CRE, MRSA, and VRE significantly increases infection risk. Screening for these organisms can guide treatment decisions for patients in high-risk areas.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Epidemiology
Background:
- Multidrug-resistant organisms (MDROs) including carbapenem-resistant Enterobacterales (CRE), methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE) pose significant healthcare challenges.
- Understanding the transition from colonization to active infection is crucial for effective infection control strategies.
Purpose of the Study:
- To estimate the risk of developing clinical MDRO infection in colonized patients compared to non-colonized patients admitted to high-risk areas.
- To specifically focus on the colonization and infection dynamics of CRE.
Main Methods:
- A retrospective cohort study was conducted at a tertiary care facility.
- Patients undergoing active surveillance testing (AST) for CRE, MRSA, or VRE in 2021 were analyzed.
- The primary outcome was the development of invasive infection within 365 days of the AST result; risk ratios were calculated to assess the association between colonization and infection.
Main Results:
- A total of 19,134 ASTs were analyzed.
- Colonization was significantly associated with an increased risk of infection for CRE (RR 4.6), MRSA (RR 8.2), and VRE (RR 22).
- In 88% of CRE cases, the infection involved the same carbapenemase gene identified during colonization, with Oxa-48/NDM Klebsiella pneumoniae being the most common.
Conclusions:
- Colonization with CRE, MRSA, or VRE is a confirmed risk factor for subsequent infection by these pathogens.
- The genetic concordance between colonization and infection suggests that AST results can inform clinical management and treatment strategies for MDROs.
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