Ahead of Print -Deaths Attributable to Carbapenem-Resistant Enterobacteriaceae Infections - Volume 20, Number 7—July 2014 - Emerging Infectious Disease journal - CDC

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Ahead of Print -Deaths Attributable to Carbapenem-Resistant Enterobacteriaceae Infections - Volume 20, Number 7—July 2014 - Emerging Infectious Disease journal - CDC

Volume 20, Number 7—July 2014

Research

Deaths Attributable to Carbapenem-ResistantEnterobacteriaceae Infections 
Deaths Attributable to Carbapenem-Resistant EnterobacteriaceaeInfections

Article Contents

• Methods
• Results
• Discussion
• Acknowledgment
• References
• Figure
• Technical Appendix - 249 KB 
• Suggested Citation

Matthew E. Falagas1 , Giannoula S. Tansarli1, Drosos E. Karageorgopoulos1, and Konstantinos Z. Vardakas1

Author affiliations: Alfa Institute of Biomedical Sciences, Athens, Greece (M.E. Falagas, G.S. Tansarli, D.E. Karageorgopoulos, K.Z. Vardakas); Hellenic Center for Disease Control and Prevention, Athens (D.E. Karageorgopoulos); IASO Group, Athens (M.E. Falagas, K.Z. Vardakas); Tufts University School of Medicine, Boston, Massachusetts, USA (M.E. Falagas)

Suggested citation for this article

Abstract

We evaluated the number of deaths attributable to carbapenem-resistantEnterobacteriaceae by using studies from around the world published before April 9, 2012. Attributable death was defined as the difference in all-cause deaths between patients with carbapenem-resistant infections and those with carbapenem-susceptible infections. Online databases were searched, and data were qualitatively synthesized and pooled in a metaanalysis. Nine studies met inclusion criteria: 6 retrospective case–control studies, 2 retrospective cohort studies, and 1 prospective cohort study. Klebsiella pneumoniae was the causative pathogen in 8 studies; bacteremia was the only infection in 5 studies. We calculated that 26%–44% of deaths in 7 studies were attributable to carbapenem resistance, and in 2 studies, which included bacteremia and other infections, −3% and −4% of deaths were attributable to carbapenem resistance. Pooled outcomes showed that the number of deaths was significantly higher in patients with carbapenem-resistant infections and that the number of deaths attributable to carbapenem resistance is considerable.

Carbapenem-resistant strains have emerged among species belonging to the Enterobacteriaceaefamily (1,2). Carbapenemases are a class of enzymes that can confer resistance to carbapenems and other β-lactam antibiotic drugs, but not all carbapenemase-producing isolates are carbapenem-resistant (3,4). Among the known carbapenemases are Klebsiella pneumoniaecarbapenemase (KPC) and Verona integrin–encoded metallo-β-lactamase (VIM) (5). Several outbreaks caused by carbapenem-resistant Enterobacteriaceae (CRE) have been recorded in health care facilities around the world (6–13), and in some places, CRE have become endemic (14–18). Serious concurrent conditions (3,4,19–22) and prior use of fluoroquinolones (20,23,24), carbapenems (22,25), or broad-spectrum cephalosporins (20,22) have been independently associated with acquisition of infections caused by CRE.

Several studies have provided data regarding clinical outcomes for CRE infections. However, controversy remains concerning the number of deaths among persons infected with CRE compared with the number among persons infected with carbapenem-susceptibleEnterobacteriaceae (CSE) (23,26). In this context, the goal of our study was to evaluate the number of deaths attributable to CRE infections by conducting a systematic review and metaanalysis of the available data.

Prof. Falagas, MD, MSc, DSc, is founder and director of the Alfa Institute of Biomedical Sciences, Athens, Greece; adjunct associate professor of Medicine at Tufts University School of Medicine, Boston, Massachusetts, USA; and director of the Department of Internal Medicine–Infectious Diseases, Iaso General Hospital, Iaso Group, Athens, Greece. His research interests include antimicrobial drug resistance and nosocomial infections.

Acknowledgment

The corresponding author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive license on a worldwide basis to the BMJ Publishing Group Ltd and its licensees to permit this article (if accepted) to be published in BMJ editions and any other BMJPGL products and sublicenses to exploit all subsidiary rights, as set out in our license.

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Figure

• Figure. Selection process for studies included in a systematic review and metaanalysis of deaths attributable to carbapenem-resistant Enterobacteriaceae infectionsCRE, carbapenem-resistant Enterobacteriaceae; CSE, carbapenem-susceptible Enterobacteriaceae; KPC, Klebsiella pneumoniae carbapenemase; ESBL, extended-spectrum β-lactamase....

Technical Appendix

• Technical Appendix. Characteristics and outcomes of studies included in a systematic review and metaanalysis of deaths attributable to carbapenem-resistant Enterobacteriaceae infections and death risk ratios for patients infected with carbapenem-resistant Enterobacteriaceae... 249 KB 

Suggested citation for this article: Falagas ME, Tansarli GS, Karageorgopoulos DE, Vardakas KZ. Deaths attributable to carbapenem-resistant Enterobacteriaceae infections. Emerg Infect Dis. 2014 Jul [date cited]. http://dx.doi.org/10.3201/eid2007. 121004

DOI: 10.3201/eid2007.121004

1All authors contributed equally to this article.