Epidemiology of carbapenem-resistant Enterobacterales infections in Tennessee, 2016-2022

This surveillance report describes the epidemiology and clinical outcomes of carbapenem-resistant Enterobacterales (CRE) infections in Tennessee from 2016 to 2022, analysing 570 cases and 406 isolates. The incidence of CRE infections per 100 000 population showed an upward trend. Enterobacter species were the most common organisms, whereas Klebsiella species were the main carbapenemase-producing CRE (CP-CRE). Klebsiella pneumoniae carbapenemase was the most common mechanism contributing to this resistance. Demographic characteristics of patients with identified isolates demonstrated a median age of 69.5 years. There were no significant differences in CP-CRE infection by sex or race. Patients with CP-CRE were more likely to be hospitalized than those with non-CP-CRE, at 60.9% and 43.9%, respectively. Multivariable analysis indicated that patients with CP-CRE had significantly higher odds of 90-day mortality (odds ratio, 2.22; 95% confidence interval, 1.12-4.42; p < 0.0001) than non-CP-CRE patients. Individuals with a higher Charlson Comorbidity Index score exhibited an increased odds of dying within 30- and 90-day post-specimen collection and had a greater likelihood of requiring intensive care unit admission. This report underscores the need to understand the epidemiology and risk factors linked to CRE infections to improve prevention strategies and patient care.