Molecular and clinical epidemiology of carbapenem-resistant Enterobacterales in the USA (CRACKLE-2): a prospective cohort study (vol 20, pg 731, 2020)

作     者：van Duin, D. Arias, C. A. Komarow, L. 

作者机构：[a]Division of Infectious Diseases University of North Carolina Chapel Hill NC USA [b]Division of Infectious Diseases and Center for Antimicrobial Resistance and Microbial Genomics UTHealth Houston TX USA [c]Center for Infectious Diseases UTHealth Houston TX USA [d]Molecular Genetics and Antimicrobial Resistance Unit International Center for Microbial Genomics Universidad El Bosque Bogota Colombia [e]The Biostatistics Center The George Washington University Rockville MD USA [f]Center for Discovery and Innovation Hackensack Meridian Health Nutley NJ USA [g]Division of Infectious Diseases Department of Medicine Montefiore Medical Center Albert Einstein College of Medicine Bronx NY USA [h]Department of Infectious Diseases Cleveland Clinic Cleveland OH USA [i]Department of Pathology and Laboratory Medicine David Geffen School of Medicine at the University of California Los Angeles CA USA [j]Division of Infectious Diseases Department of Medicine Emory University School of Medicine Atlanta GA USA [k]Division of Infectious Diseases Weill Cornell Medicine New York-Presbyterian Hospital New York NY USA [l]Department of Medicine Division of Infectious Diseases Stony Brook University Stony Brook NY USA [m]Department of Infectious Diseases Ochsner Clinic Foundation New Orleans LA USA [n]Division of Infectious Diseases University of Pittsburgh School of Medicine Pittsburgh PA USA [o]Departments of Microbiology and Infectious Diseases Fujita Health University School of Medicine Aichi Japan [p]Division of Infectious Diseases Detroit Medical Center Wayne State University Detroit MI USA [q]Division of Infectious Diseases University of Michigan Ann Arbor MI USA [r]Louis Stokes Cleveland Department of Veterans Affairs Medical Center Cleveland OH USA [s]Department of Medicine Case Western Reserve University School of Medicine Cleveland OH USA [t]Institute of Antibiotics Huashan Hospital Fudan University Shanghai China [u]University of Queensland Centre for Clinical Research Royal Brisbane and Women's Hospital Campus QL Australia [v]Division of Pediatric Infectious Diseases Vanderbilt University Medical Center Nashville TN USA [w]Division of Clinical Microbiology Department of Laboratory Medicine and Pathology and Division of Infectious Diseases Department of Medicine Mayo Clinic Rochester MN USA [x]Duke Clinical Research Institute Duke University Medical Center Durham NC USA [y]Department of Medicine University of California San Francisco San Francisco CA USA [z]Division of Infectious Diseases Duke University Durham NC USA [aa]Departments of Pharmacology Molecular Biology and Microbiology Biochemistry and Proteomics and Bioinformatics Case Western Reserve University School of Medicine Cleveland OH USA [ab]CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology Cleveland OH USA 

出 版 物：《LANCET INFECTIOUS DISEASES》 (柳叶刀：传染病)

年 卷 期：2020年第20卷第6期

页      面：E116-E116页

核心收录：

学科分类：1004[医学-公共卫生与预防医学(可授医学、理学学位)] 1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：Cleveland Department of Veterans Affairs Geriatric Research Education and Clinical Center National Institutes of Health, NIH National Institute of Allergy and Infectious Diseases, NIAID, (K08AI113317, K24AI121296, R01AI063517, R01AI072219, R01AI090155, R01AI100560, R01AI104895, R01AI134637, R01AI143910, R21AI114508, R21AI117338, R21AI123747, R21AI135250, R21AI135522, R21AI143229, UM1AI104681) National Institute of Allergy and Infectious Diseases, NIAID U.S. Department of Veterans Affairs, VA, (1I01BX001974) U.S. Department of Veterans Affairs, VA College Art Association, CAA Biomedical Laboratory Research and Development, VA Office of Research and Development, BLR&D, ORD Wellcome Trust, WT, (2K24-AI093969, K08-AI113317) Wellcome Trust, WT University of Texas Health Science Center at Houston Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, DMID, NIAID, (10–0065, R01AI119446) Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, DMID, NIAID Geriatric Research Education and Clinical Center, GRECC Case Alumni Association, CAA European Society of Clinical Microbiology and Infectious Diseases, ESCMID, (0065) European Society of Clinical Microbiology and Infectious Diseases, ESCMID 

摘      要：Summary Background Carbapenem-resistant Enterobacterales (CRE) are a global threat. We aimed to describe the clinical and molecular characteristics of Centers for Disease Control and Prevention (CDC)-defined CRE in the *** CRACKLE-2 is a prospective, multicentre, cohort study. Patients hospitalised in 49 US hospitals, with clinical cultures positive for CDC-defined CRE between April 30, 2016, and Aug 31, 2017, were included. There was no age exclusion. The primary outcome was desirability of outcome ranking (DOOR) at 30 days after index culture. Clinical data and bacteria were collected, and whole genome sequencing was done. This trial is registered with ***, number *** 1040 patients with unique isolates were included, 449 (43%) with infection and 591 (57%) with colonisation. The CDC-defined CRE admission rate was 57 per 100 000 admissions (95% CI 45-71). Three subsets of CDC-defined CRE were identified: carbapenemase-producing Enterobacterales (618 [59%] of 1040), non-carbapenemase-producing Enterobacterales (194 [19%]), and unconfirmed CRE (228 [22%]; initially reported as CRE, but susceptible to carbapenems in two central laboratories). Klebsiella pneumoniae carbapenemase-producing clonal group 258 K pneumoniae was the most common carbapenemase-producing Enterobacterales. In 449 patients with CDC-defined CRE infections, DOOR outcomes were not significantly different in patients with carbapenemase-producing Enterobacterales, non-carbapenemase-producing Enterobacterales, and unconfirmed CRE. At 30 days 107 (24%, 95% CI 20-28) of these patients had *** Among patients with CDC-defined CRE, similar outcomes were observed among three subgroups, including the novel unconfirmed CRE group. CDC-defined CRE represent diverse bacteria, whose spread might not respond to interventions directed to carbapenemase-producing *** National Institutes of Health.