Table 1.
Baseline characteristics of adult hospitalized patients with carbapenem-resistant bloodstream infections and matched controls with carbapenem-susceptible bloodstream infection, or without Enterobacterales infection, admitted to 18 European hospitals between March 2016 and November 2018
| Variables | Patients with CRE BSI (N = 73) | Matched patients with CSE BSI (N = 73) | Matched patients without Enterobacterales infection (N = 219) | Comparison between CRE and CSE BSI patients P valuea |
Comparison between CRE and uninfected patients P valuea |
|---|---|---|---|---|---|
| Demographic information | |||||
| Age, y, median (IQR) | 69.0 (59.5–77.0) | 70.0 (59.0–80.0) | 64.0 (51.0–75.0) | 0.639 | 0.009 |
| Male sex, n (%) | 40 (54.8) | 38 (52.1) | 131 (59.8) | 0.732 | 0.447 |
| BMI, kg/m2, median (IQR)b | 25.5 (23.7–29.2) | 25.4 (21.8–27.9) | 25.1 (22.9–28.7) | 0.182 | 0.977 |
| BMI <25 kg/m2, n (%) | 31 (44.9) | 31 (43.1) | 104 (48.1) | 0.931 | 0.806 |
| BMI 25–29 kg/m2, n (%) | 27 (39.1) | 31 (43.1) | 73 (33.8) | ||
| BMI ≥ 30 kg/m2, n (%) | 11 (15.9) | 10 (13.9) | 39 (18.1) | ||
| Country of origin, n (%) | |||||
| Spain | 27 (37.0) | 29 (39.7) | 88 (40.2) | 0.503 | 0.155 |
| Greece | 16 (21.9) | 16 (21.9) | 44 (20.1) | ||
| Serbia | 16 (21.9) | 15 (20.5) | 44 (20.1) | ||
| Italy | 7 (9.6) | 7 (9.6) | 15 (6.8) | ||
| Turkey | 3 (4.1) | 2 (2.7) | 9 (4.1) | ||
| Romania | 2 (2.7) | 1 (1.4) | 5 (2.3) | ||
| Other | 2 (2.7) | 3 (4.1) | 14 (6.4) | ||
| Hospital admission characteristics, n (%) | |||||
| Patient referral | |||||
| Home | 50 (68.5) | 60 (82.2) | 191 (87.2) | 0.071 | <0.001 |
| Long-term care facility | 9 (12.3) | 4 (5.5) | 11 (5.0) | ||
| Another acute care hospital | 14 (19.2) | 9 (12.3) | 17 (7.8) | ||
| Emergency admission | 2 (2.7) | 3 (4.1) | 13 (5.9) | 0.657 | 0.206 |
| Hospital service on enrollmentc | |||||
| Medical | 46 (63.0) | 46 (63.0) | 138 (63.0) | 1.000 | 1.000 |
| Surgical | 13 (17.8) | 13 (17.8) | 39 (17.8) | ||
| ICU | 14 (19.2) | 14 (19.2) | 42 (19.2) | ||
| Length of hospital stay before enrolment ≥1 d | 51 (69.9) | 48 (65.8) | 141 (64.4) | 0.327 | 0.023 |
| Clinical characteristics | |||||
| Comorbidities | |||||
| Charlson comorbidity index, median (IQR) | 2.0 (1.0–3.0) | 2.0 (1.0–4.0) | 2.0 (1.0–3.0) | 0.683 | 0.203 |
| Myocardial infarction, n (%) | 9 (12.3) | 9 (12.3) | 17 (7.8) | 1.000 | 0.230 |
| Congestive heart failure: NYHA grade ≥2, n (%) | 10 (13.7) | 8 (11.0) | 31 (14.2) | 0.618 | 0.909 |
| Peripheral artery disease, n (%) | 14 (19.2) | 12 (16.4) | 46 (21.0) | 0.618 | 0.713 |
| Cerebrovascular disease, n (%) | 5 (6.8) | 5 (6.8) | 10 (4.8) | 1.000 | 0.402 |
| Dementia, n (%) | 6 (8.2) | 7 (9.6) | 7 (3.2) | 0.763 | 0.090 |
| Chronic pulmonary disease, n (%) | 6 (8.2) | 11 (15.1) | 30 (13.7) | 0.206 | 0.206 |
| Connective tissue disease, n (%) | 4 (5.5) | 2 (2.7) | 10 (4.6) | 0.423 | 0.752 |
| Ulcerative disease, n (%) | 2 (2.7) | 3 (4.1) | 9 (4.1) | 0.571 | 0.580 |
| Mild liver disease, n (%) | 5 (6.8) | 2 (2.7) | 9 (4.1) | 0.215 | 0.336 |
| Severe liver disease, n (%) | 1 (1.4) | 1 (1.4) | 8 (3.7) | 1.000 | 0.318 |
| Diabetes mellitus without organ damage, n (%) | 17 (23.3) | 18 (24.7) | 40 (18.3) | 0.827 | 0.334 |
| Diabetes with target organ damage, n (%) | 5 (6.8) | 10 (13.7) | 15 (6.8) | 0.206 | 1.000 |
| Hemiplegia, n (%) | 4 (5.5) | 3 (4.1) | 4 (1.8) | 0.706 | 0.120 |
| Moderate or severe kidney disease, n (%) | 15 (20.5) | 8 (11.0) | 31 (14.2) | 0.083 | 0.108 |
| Metastatic solid tumour, n (%) | 3 (4.1) | 5 (6.8) | 8 (3.7) | 0.484 | 0.847 |
| Any tumour, not metastasic, n (%) | 14 (19.2) | 13 (17.8) | 30 (13.7) | 0.827 | 0.214 |
| Leukaemia, n (%) | 4 (5.5) | 5 (6.8) | 11 (5.0) | 0.706 | 0.842 |
| Lymphoma, n (%) | 4 (5.5) | 4 (5.5) | 12 (5.5) | 1.000 | 1.000 |
| AIDS, n (%) | 0 (0.0) | 1 (1.4) | 3 (1.4) | 0.998 | 0.998 |
| HIV infection with <200 CD4/mm3, n (%) | 0/72 (0.0) | 1/71 (1.4) | 4/218 (1.8) | 0.998 | 0.998 |
| Immunosuppressiond, n (%) | 20 (27.4) | 23 (31.5) | 54 (24.7) | 0.514 | 0.549 |
| Invasive procedures within 3 mo before enrolment, n (%) | 51 (69.9) | 46 (63.0) | 96 (43.8) | 0.321 | <0.001 |
| Surgery during the previous month, n (%) | 22 (30.1) | 23 (31.5) | 53 (24.2) | 0.796 | 0.176 |
| Endoscopic procedure in the week before enrolment, n (%) | 5 (6.8) | 8 (11.0) | 12 (5.5) | 0.372 | 0.623 |
| CRE exposure risk, n (%) | |||||
| CRE exposure risk in community in the last 6 mo | |||||
| Travel abroad | 2/71 (2.8) | 1/73 (1.4) | 17/218 (7.8) | 0.571 | 0.175 |
| Contact with pets at home | 9/71 (12.7) | 9/70 (12.9) | 34/209 (16.3) | 1.000 | 0.315 |
| Frequent contact with livestock | 0/71 (0.0) | 0/72 (0.0) | 5/212 (2.4) | — | 0.997 |
| Ambulatory contact with persons known to be colonized by CRE | 6/57 (10.5) | 2/56 (3.6) | 4/177 (2.3) | 0.998 | 0.998 |
| CRE exposure risk in healthcare facility | |||||
| Patient worked as healthcare worker or caregiver during last year | 1 (1.4) | 0 (0.0) | 2/215 (0.9) | 0.998 | 0.741 |
| Another patient/s with CRE in the same ward during present admission | 29/70 (41.4) | 27/69 (39.1) | 86/217 (39.6) | 0.514 | 0.579 |
| Previous hospitalization during the last 6 mo | 40 (54.8) | 32 (43.8) | 72 (32.9) | 0.174 | 0.001 |
| Nursing home or other long term-care facility residency during the last 6 mo | 10 (13.8) | 9 (12.3) | 9 (4.1) | 0.796 | 0.005 |
| Chronic dialysis | 8 (11.0) | 5 (6.8) | 14 (6.4) | 0.372 | 0.140 |
| Haemodialysis | 7 (9.6) | 5 (6.8) | 10 (4.6) | 0.530 | 0.061 |
| Peritoneal dialysis | 1 (1.4) | 0 (0.0) | 4 (1.8) | 0.998 | 0.782 |
| Evidence of previous colonization/infection with CRE | 18/68 (26.5) | 3/72 (4.2) | 1/217 (0.5) | 0.004 | <0.001 |
| Evidence of previous colonization/infection with other MDROs (MRSA, VRE, ESBL-producer) | 12/71 (16.9) | 7/71 (9.9) | 14/217 (6.5) | 0.147 | 0.005 |
| Antimicrobial exposure within 3 mo before enrolment | 53 (72.6) | 48 (65.8) | 123 (56.2) | 0.339 | 0.008 |
| Colistin | 7 (9.6) | 7 (9.6) | 11 (5.0) | 1.000 | 0.061 |
| Aminoglycosides | 8 (11.0) | 6 (8.2) | 13 (5.9) | 0.566 | 0.131 |
| Quinolones | 21 (28.8) | 15 (20.5) | 50 (22.8) | 0.277 | 0.298 |
| Macrolides | 2 (2.7) | 3 (4.1) | 4 (1.8) | 0.657 | 0.640 |
| Cephalosporins, first/second generation | 9 (12.3) | 13 (17.8) | 20 (9.1) | 0.292 | 0.339 |
| Cephalosporins, third/fourth generation | 20 (27.4) | 15 (20.5) | 38 (17.4) | 0.321 | 0.043 |
| Carbapenems | 21 (28.8) | 8 (11.0) | 25 (11.4) | 0.011 | <0.001 |
| β-lactam + β-lactamase inhibitor | 28 (38.4) | 21 (28.8) | 44 (20.1) | 0.183 | 0.001 |
| Other β-lactam antibiotics | 7 (9.6) | 10 (13.7) | 4 (1.8) | 0.372 | 0.007 |
| Active against Gram-positive only | 22 (30.1) | 12 (16.4) | 28 (12.8) | 0.004 | 0.001 |
| Other | 14 (19.2) | 17 (23.3) | 35 (16.0) | 0.549 | 0.454 |
BSI, bloodstream infection; CRE, carbapenem-resistant Enterobacterales; CSE, carbapenem-susceptible Enterobacterales; MDROs, multidrug-resistant organisms; NYHA, New York Heart Association.
aBased on univariable conditional logistic regression, in case of categorical variables it refers to the likelihood ratio test.
bThe denominators for patients with CRE BSI, CSE BSI and without Enterobacterales infection are 69, 72 and 216, respectively.
cMatching variable for patients with CRE BSI versus patients with CSE BSI and patients without Enterobacterales infection, respectively.
dImmunosuppression was defined as the receipt of solid organ transplantation, bone marrow/stem cell transplantation or immunosupressive drugs (including cancer chemotherapy, classic immunosuppressants, biologicals or steroids) within 3 mo before enrolment, or with neutropenia (<500 cells/mm3) on enrolment.