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Carbapenem-resistant Enterobacteriaceae: A retrospective review of treatment and outcomes in a long-term acute care hospital

Published:August 17, 2019DOI:https://doi.org/10.1016/j.ajic.2019.07.006

      Highlights

      • This is a retrospective analysis of our clinical experience treating CRE infections in an LTACH.
      • Current treatment paradigms for infections caused by CRE have produced suboptimal results.
      • We propose an algorithmic approach when an infection with CRE is suspected.

      Background

      Long-term acute care hospitals (LTACHs) have a unique patient population, with multiple risk factors for carbapenem-resistant Enterobacteriaceae (CRE) colonization and infection.

      Methods

      We performed a retrospective analysis of patients in LTACHs who were diagnosed with and treated for CRE infections. Baseline data, antimicrobial treatment, and outcomes were collected in patients with bacteremia, health care–associated pneumonia, and complicated urinary tract infection/acute pyelonephritis due to CRE diagnosed between January 2017 and December 2017.

      Results

      A total of 57 cases of CRE infection were identified over the study period, including 12 cases of bacteremia, 20 cases of health care–associated pneumonia, and 25 cases of complicated urinary tract infection/acute pyelonephritis. Patient had significant comorbidities: 31.5% with diabetes, 40.4% with heart failure, 29.8% with kidney disease, and 10% with solid tumors. The majority (56) of 57 patients received empiric antibiotics known to have activity against gram-negative bacteria, but only 38.6% had in vitro activity against the CRE organism in cultured specimens. A total of 78.9% of patients received monotherapy. Overall outcome was poor, with 28-day mortality across all infection sites of 17.5% in patients but up to 25% in patients with bacteremia.

      Conclusions

      In this retrospective analysis of our clinical experience treating CRE infections in an LTACH setting, we documented that CRE infections occur in patients with substantial comorbidities. Although clinical outcome remains of great concern, the 28-day mortality and rate of eradication of CRE in this study were comparatively better than other national estimates. Inappropriate empiric treatment may be one of many factors leading to overall poor treatment outcomes.

      Key Words

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