Please use this identifier to cite or link to this item: https://doi.org/10.1371/journal.pone.0034254
Title: Risk factors, molecular epidemiology and outcomes of ertapenem-resistant, carbapenem-susceptible enterobacteriaceae: A case-case-control study
Authors: Teo J.
Cai Y.
Tang S.
Lee W.
Tan T.Y.
Tan T.T. 
Kwa A.L.-H. 
Keywords: amikacin
aminoglycoside
amoxicillin plus clavulanic acid
antibiotic agent
beta lactamase AmpC
carbapenem
cefepime
ceftriaxone
cephalosporin
ciprofloxacin
ertapenem
extended spectrum beta lactamase
gentamicin
penicillin G
piperacillin plus tazobactam
porin
antiinfective agent
beta lactam
carbapenem derivative
ertapenem
adult
aged
antibiotic resistance
antibiotic sensitivity
article
bacterium isolate
carbapenem susceptible Enterobacteriaceae
case control study
clonal variation
comorbidity
controlled study
demography
drug exposure
drug response
Enterobacteriaceae
Enterobacteriaceae infection
ertapenem resistant Enterobacteriaceae
female
hospital patient
hospitalization
human
independent variable
instrumentation
major clinical study
male
molecular epidemiology
mortality
multivariate logistic regression analysis
outcome assessment
retrospective study
risk factor
Singapore
tertiary health care
treatment duration
adolescent
cross infection
drug effect
Enterobacteriaceae infection
growth, development and aging
microbiology
middle aged
multidrug resistance
multivariate analysis
Singapore
statistical model
treatment outcome
Enterobacteriaceae
Negibacteria
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents
beta-Lactams
Carbapenems
Case-Control Studies
Cross Infection
Drug Resistance, Microbial
Drug Resistance, Multiple, Bacterial
Enterobacteriaceae
Enterobacteriaceae Infections
Female
Humans
Logistic Models
Male
Middle Aged
Molecular Epidemiology
Multivariate Analysis
Risk Factors
Singapore
Treatment Outcome
Young Adult
Issue Date: 2012
Citation: Teo J., Cai Y., Tang S., Lee W., Tan T.Y., Tan T.T., Kwa A.L.-H. (2012). Risk factors, molecular epidemiology and outcomes of ertapenem-resistant, carbapenem-susceptible enterobacteriaceae: A case-case-control study. PLoS ONE 7 (3) : e34254. ScholarBank@NUS Repository. https://doi.org/10.1371/journal.pone.0034254
Abstract: Background: Increasing prevalence of ertapenem-resistant, carbapenem-susceptible Enterobacteriaceae (ERE) in Singapore presents a major therapeutic problem. Our objective was to determine risk factors associated with the acquisition of ERE in hospitalized patients; to assess associated patient outcomes; and to describe the molecular characteristics of ERE. Methods: A retrospective case-case-control study was conducted in 2009 at a tertiary care hospital. Hospitalized patients with ERE and those with ertapenem-sensitive Enterobacteriaceae (ESE) were compared with a common control group consisting of patients with no prior gram-negative infections. Risk factors analyzed included demographics; co-morbidities; instrumentation and antibiotic exposures. Two parallel multivariate logistic regression models were performed to identify independent variables associated with ERE and ESE acquisition respectively. Clinical outcomes were compared between ERE and ESE patients. Results: Twenty-nine ERE cases, 29 ESE cases and 87 controls were analyzed. Multivariate logistic regression showed that previous hospitalization (Odds ratio [OR], 10.40; 95% confidence interval [CI], 2.19-49.20) and duration of fluoroquinolones exposure (OR, 1.18 per day increase; 95% CI, 1.05-1.34) were unique independent predictors for acquiring ERE. Duration of 4 th-generation cephalosporin exposure was found to predict for ESE acquisition (OR, 1.63 per day increase; 95% CI, 1.05-2.54). In-hospital mortality rates and clinical response rates were significantly different between ERE and ESE groups, however ERE infection was not a predictor of mortality. ERE isolates were clonally distinct. Ertapenem resistance was likely to be mediated by the presence of extended-spectrum ?-lactamases or plasmid-borne AmpC in combination with impermeability due to porin loss and/or efflux pumps. Conclusion: Prior hospitalization and duration of fluoroquinolone treatment were predictors of ERE acquisition. ERE infections were associated with higher mortality rates and poorer clinical response rates when compared to ESE infections. © 2012 Teo et al.
Source Title: PLoS ONE
URI: https://scholarbank.nus.edu.sg/handle/10635/161993
ISSN: 19326203
DOI: 10.1371/journal.pone.0034254
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