Table 2.
Exposure to the different variables in the three patient-groups
| CRE group (n = 235) n (%) | CSE group (n = 235) n (%) | p | Non-infected group (n = 705) n (%) | p | |
|---|---|---|---|---|---|
| Demographics and epidemiological context | |||||
| Age (years), median (IQR) | 73 (62–82) | 70 (59–79) | 0.081 | 67 (53–77) | <0.001 |
| Male sex | 134 (57.0) | 126 (53.6) | 0.42 | 412 (58.4) | 0.69 |
| Caucasian ethnicity | 231 (98.3) | 229 (97.4) | 0.42 | 690 (97.9) | 0.63 |
| Present admission from: | |||||
| Home | 174 (74.0) | 203 (86.4) | 0.001 | 637 (90.4) | <0.001 |
| Nursing home | 9 (3.8) | 9 (3.8) | 1.0 | 9 (1.3) | 0.015 |
| Other long term-care facility | 19 (8.1) | 7 (3.0) | 0.01 | 10 (1.4) | <0.001 |
| Another acute care hospital | 32 (13.6) | 16 (6.8) | 0.01 | 49 (7) | 0.001 |
| Previous acute care hospitalization (last 6 months) | 150 (63.8) | 104 (44.3) | <0.001 | 224 (31.8) | <0.001 |
| Travel abroad (last 6 months) | 4 (1.7) | 3 (1.7) | 0.56 | 35 (5.0) | 0.037 |
| Household/residency mates colonized/infected by CRE | 15 (6.4) | 11 (4.7) | 0.46 | 6 (0.9) | <0.001 |
| Other patient(s) colonized/infected by CRE in the same ward during admission | 77 (32.8) | 66 (28.1) | 0.22 | 248 (35.2) | 0.35 |
| Healthcare worker or caregiver of dependant person | 1 (0.4) | 4 (1.7) | 0.21 | 7 (1.0) | 0.42 |
| Usual contact with pets, last 6 months | 33 (14.0) | 32 (13.6) | 0.88 | 110 (15.6) | 0.42 |
| Any contact with farm animals, last 6 months | 1 (0.4) | 5 (2.1) | 0.14 | 16 (2.3) | 0.092 |
| Mean days of previous stay (SD) | 9.2 (15.1) | 7.4 (13.7) | <0.001 | 7.7 (10.4) | <0.001 |
| Previous colonisation/infection by CREa | 50 (21.3) | 8 (3.4) | <0.001 | 6 (0.9) | <0.001 |
| Previous colonization/infection by other MDROb | 25 (10.6) | 18 (7.7) | 0.18 | 24 (3.4) | <0.001 |
| Type of acquisition of infectionc | |||||
| Nosocomial | 138 (58.7) | 138 (58.7) | 1.00 | – | – |
| Community-onset, healthcare-associated | 79 (33.6) | 51 (21.7) | <0.001 | – | – |
| Community-acquired | 18 (7.7) | 46 (19.6) | <0.001 | – | – |
| Chronic comorbidities and conditions | |||||
| Charlson index, median (IQR) | 3 (2–4) | 2 (1–4) | 0.008 | 2 (0–3.5) | <0.001 |
| Obesity (Body mass index >30) | 35 (15.2) | 39 (16.7) | 0.61 | 106 (15.1) | 0.98 |
| Diabetes mellitus | 70 (29.8) | 66 (28.1) | 0.66 | 170 (24.1) | 0.083 |
| Chronic pulmonary disease | 44 (18.7) | 36 (15.3) | 0.31 | 109 (15.5) | 0.22 |
| Chronic heart failure (NYHA ≥ 2) | 44 (18.7) | 28 (11.9) | 0.038 | 84 (11.9) | 0.005 |
| Dementia | 37 (15.7) | 22 (9.4) | 0.025 | 34 (4.8) | <0.001 |
| Hemiplegia | 15 (6.4) | 9 (3.8) | 0.22 | 14 (2.0) | 0.002 |
| Chronic liver disease | 15 (6.4) | 14 (6.0) | 0.83 | 64 (9.1) | 0.63 |
| Chronic renal failure (moderate or severe) | 65 (27.7) | 33 (14) | <0.001 | 88 (12.5) | <0.001 |
| Structural disease of the urinary tract | 48 (20.4) | 40 (17) | 0.21 | 0 (0) | 0.001 |
| Connective tissue disease | 8 (3.4) | 7 (3.0) | 0.79 | 26 (3.7) | 0.83 |
| Solid organ cancer | 64 (27.2) | 57 (24.3) | 0.41 | 143 (20.3) | 0.014 |
| Hematologic cancer | 12 (5.1) | 12 (5.1) | 1.00 | 35 (5.0) | 0.90 |
| Bone marrow/stem cell transplantation | 1 (0.4) | 1 (0.4) | 1.00 | 10 (1.4) | 0.17 |
| Neutropenia (<500 cels/μL) | 13 (5.8) | 8 (3.4) | 0.23 | 27 (3.8) | 0.13 |
| Solid organ transplantation | 16 (6.8) | 13 (5.5) | 0.53 | 28 (4) | 0.028 |
| HIV infection | 1 (0.4) | 2 (0.9) | 0.57 | 14 (2) | 0.14 |
| Invasive procedures or therapies | |||||
| Central venous catheter (last week) | 78 (33.2) | 60 (25.5) | 0.020 | 152 (21.6) | <0.001 |
| Urinary catheter (last week) | 153 (65.1) | 120 (51.1) | 0.001 | 216 (30.6) | <0.001 |
| Mechanical ventilation (last week) | 42 (17.9) | 45 (19.1) | 0.58 | 96 (13.6) | 0.013 |
| Major surgery last month (needing hospital admission) | 71 (30.2) | 65 (27.7) | 0.41 | 133 (18.9) | <0.001 |
| Endoscopic procedure (last week) | 16 (6.8) | 18 (7.7) | 0.72 | 30 (4.3) | 0.087 |
| Chronic dialysis | 23 (9.8) | 8 (3.4) | 0.008 | 34 (4.8) | 0.001 |
| Immunosupressive drugs (last 3 months) | 59 (25.1) | 52 (22.1) | 0.40 | 121 (17.2) | 0.002 |
| Exposure to antibacterial agents (last 3 months) | |||||
| Any antibiotic received | 186 (79.1) | 150 (63.8) | <0.001 | 370 (52.5) | <0.001 |
| Median no. of antibiotics received (IQR) | 2 (1–3) | 1 (0–2) | <0.001 | 1 (0–2) | <0.001 |
| Mean days of antibiotics (SD) | 18.3 (21.6) | 11.2 (17.1) | <0.001 | 11.0 (23.4) | <0.001 |
| Carbapenemsd | 33 (14.0) | 14 (6.0) | 0.010 | 57 (8.1) | 0.004 |
| Mean days of carbapenemsd (SD) | 1.2 (3.5) | 0.4 (2.2) | 0.011 | 0.7 (3.3) | 0.027 |
| Piperacillin-tazobactam | 45 (19.1) | 22 (9.4) | <0.001 | 64 (9.1) | <0.001 |
| Mean days of piperacillin-tazobactam (SD) | 1.5 (4.0) | 0.7 (2.6) | 0.05 | 0.7 (2.6) | <0.001 |
| Fluoroquinolonese | 87 (37.0) | 56 (23.8) | 0.003 | 146 (20.7) | <0.001 |
| Mean days of fluoroquinolonese (SD) | 3.2 (5.0) | 2.3 (5.4) | 0.007 | 1.9 (5.4) | 0.003 |
| Oxyimino β-lactamsf | 83 (35.3) | 57 (24.3) | 0.011 | 143 (20.3) | <0.001 |
| Mean days of oxyimino β-lactamsf (SD) | 3.5 (7.3) | 2.0 (4.4) | 0.015 | 1.5 (4.1) | <0.001 |
| Amoxicillin-clavulanic acid or ampicillin-sulbactam | 38 (16.2) | 36 (15.3) | 0.80 | 65 (9.2) | 0.003 |
| Mean days of amoxicillin-clavulanic acid or ampicillin-sulbactam (SD) | 1.0 (2.8) | 1.4 (4.6) | 0.89 | 0.6 (2.3) | 0.024 |
| Aminoglycosidesg | 18 (7.7) | 10 (4.2) | 0.003 | 24 (3.4) | 0.009 |
| Mean days of aminoglycosidesg (SD) | 0.5 (2.0) | 0.2 (1.2) | 0.079 | 0.1 (1.2) | 0.023 |
| Broad-spectrum anti-gram negative drugsh | 164 (69.8) | 115 (48.9) | <0.001 | 277 (39.3) | <0.001 |
| Mean days of broad-spectrum anti-gram negative drugsh (SD) | 9.4 (10.0) | 5.5 (8.2) | <0.001 | 5.0 (8.8) | <0.001 |
| Antianaerobic drugsi | 106 (45.1) | 73 (31.1) | 0.001 | 201 (28.5) | <0.001 |
| Mean days of antianaerobic drugsi (SD) | 5.4 (8.4) | 3.4 (6.8) | 0.003 | 3.5 (6.9) | <0.001 |
| Anti-gram positive drugsj | 39 (16.6) | 17 (7.2) | 0.001 | 52 (7.4) | <0.001 |
| Mean days of anti-gram positive drugsj (SD) | 1.6 (4.6) | 0.5 (2.8) | 0.008 | 0.5 (2.6) | <0.001 |
| Time of exposure to broad-spectrum drugs | <0.001 | <0.001 | |||
| No broad spectrum anti-gram negative drugs,h | 70 (29.8) | 119 (50.6) | 427 (60.6) | ||
| Broad spectrum anti-gram negative drugs,h <6 days | 24 (10.2) | 32 (13.6) | 52 (7.4) | ||
| Broad spectrum anti-gram negative drugs,h ≥6 days | 141 (60.0) | 84 (35.7) | 226 (32.1) | ||
| Number of broad-spectrum anti-gram negative drugs | <0.001 | <0.001 | |||
| None | 50 (21.3) | 96 (40.9) | 351 (49.8) | ||
| One | 121 (51.5) | 112 (47.6) | 259 (36.7) | ||
| ≥2 | 64 (27.2) | 27 (11.5) | 95 (13.5) |
Data are number of patients (percentage) except where specified.
CRE: carbapenem-resistant Enterobacterales. CSE: carbapenem-susceptible Enterobacterales. SD: standard deviation.
Evidence of any previous positive culture (screening or clinical samples) with isolation of CRE; if no evidence was available (e.g., no previous culture results with CRE), it was considered as no exposure.
As above, for ESBL- or AmpC producing Enterobacterales, carbapenem-resistant Pseudomonas aeruginosa or Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus, or vancomycin-resistant enterococci.
Nosocomial: infection occurring after 48 h of hospital admission or in <7 days after a previous hospital discharge; community-onset, healthcare-associated infection: those not nosocomially-acquired, in patients with any of the following in the last 3 months: admission to acute or long term-care facility, intravenous therapy, major surgery, specialised home care, renal replacement therapy; community-acquired: all others.
Ertapenem, meropenem, imipenem.
Ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin.
2nd, 3rd and 4th generation cephalosporins (except cephamycins), and aztreonam.
Amikacin, gentamicin, tobramycin.
Carbapenems, fluoroquinolones, piperacillin-tazobactam and oxyimino-β-lactams.
Carbapenems, β-lactam-β-lactam inhibitors, cephamycins, moxifloxacin, metronidazol, tigecycline, clindamycin.
Vancomycin, teicoplanin, linezolid, daptomycin. Definitions for other variables are in the study protocol (Annex A).