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Table 3 Studies of the Association between CRE Infection and Outcome

From: A systematic review of the epidemiology of carbapenem-resistant Enterobacteriaceae in the United States

First Author (Year) Study Population CLSI protocol Study Period No. of Patients Types of infections Mortality: CRE versus control (%)
HR or OR (95% CI)
Length of stay (LOS), median (IQR), days Discharge to a LTAC after being admitted from home (%), OR (95% CI)
CRE infected patients versus uninfected controls
 Bogan (2014) [20] Detroit Medical Center, 8 hospitals M100-S19 2009 09/2008–08/2009 91 cases, 91 controls (matched) All classified by NHSN definitions.1 All-cause in-hospital
38.3% versus 16.7% (p = 0.006), adjusted OR = 1.6 (0.2–14.8)2
CRE Infected Pts Median = 10 days (IQR: 4–23)
Uninfected Pts
Median = 13 days (IQR: 3–25)
OR = 15.1 (3.1–73.5)
 Kalpoe (2012) [23] Mount Sinai Hospital, New York City Not stated 10/2005–10/2006 14 cases, 161 controls Cultures positive for carbapenem-resistant K.pneumoniae from normally sterile body-sites All-cause mortality at 1-year: 71% versus 14% (log rank p < 0.001)
HR = 4.9 (1.5–15.6)
  
Carbapenem-resistant Enterobacteriaceae (CRE) versus carbapenem-susceptible Enterobacteriaceae (CSE)
 Gasink (2009) [21] University of Pennsylvania (2 hospitals) KPC-production3 10/2006–4/2008 56 cases, 863 controls Clinical cultures with K.pneumoniae4 All-cause in-hospital: 32.1% versus 9.9% (p < 0.001), adjusted OR 2.28 (1.18–4.40)   
 Patel (2008) [22] Mount Sinai Hospital, New York City M100-S16 2006 7/2004–6/2006 99 cases, 99 controls (matched) Cultures positive for K. pneumoniae from normally sterile body-sites All-cause in-hospital: 48% versus 20%, OR 3.71 (1.97–7.01)
Attributable in-hospital: OR 4.50 (2.16–9.35)
  
 Bogan (2014) [20] Detroit Medical Center, 8 hospitals M100-S19 2009 09/2008–08/2009 91 cases, 91 controls (matched) CRE or non-ESBL CSE. All infections classified by NHSN definitions.1 All-cause in-hospital: 38.3% versus 16.7% (p = 0.004), adjusted OR 2.7 (0.8–9.4) Among CRE Pts Median = 10 days (IQR: 4–23)
Among CSE Pts
Median = 7 days (IQR: 5–16)
OR = 14.5 (2.7–79.8)
  1. CI confidence interval, CRE carbapenem-resistant Enterobacteriaceae, CSE carbapenem-susceptible Enterobacteriaceae, HR hazard ratio, IQR interquartile range, KPC Klebsiella pneumoniae carbapenemase, LTAC long-term acute-care facility, NHSN National Healthcare Safety Network, OR odds ratio
  2. 1Infectious clinical syndrome for CRE cases: 28.2% colonization, 19.7% UTI, 19.7% pneumonia, remaining syndromes not stated
  3. 2Excludes uninfected colonized-only CRE patients and their matched controls
  4. 3All cases had confirmed production of a Klebsiella pneumoniae carbapenemase (KPC) by either PCR for blaKPC or the Modified Hodge Test
  5. 4Body site of positive-culture: urine 59.9%, blood 17.3%, respiratory tract 12.1%, abdomen 8.1%, other 6.6%