Molecular and clinical epidemiology of carbapenem-resistant Enterobacterales in the USA (CRACKLE-2): a prospective cohort study

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dc.contributor.authorVan Duin, David
dc.contributor.authorArias, Cesar A.
dc.contributor.authorKomarow, Lauren
dc.contributor.authorChen, Liang
dc.contributor.authorHanson, Blake M.
dc.contributor.authorWeston, Gregory
dc.contributor.authorCober, Eric
dc.contributor.authorGarner, Omai B.
dc.contributor.authorJacob, Jesse T.
dc.contributor.authorSatlin, Michael J.
dc.contributor.authorFries, Bettina C.
dc.contributor.authorGarcia Diaz, Julia
dc.contributor.authorDoi, Yohei
dc.contributor.authorDhar, Sorabh
dc.contributor.authorKaye, Keith S.
dc.contributor.authorEarley, Michelle
dc.contributor.authorHujer, Andrea M.
dc.contributor.authorHujer, Kristine M.
dc.contributor.authorDomitrovic, T. Nicholas
dc.contributor.authorShropshire, William C.
dc.contributor.authorDinh, An
dc.contributor.authorManca, Claudia
dc.contributor.authorLuterbach, Courtney L.
dc.contributor.authorWang, Minggui
dc.contributor.authorPaterson, David L.
dc.contributor.authorBanerjee, Ritu
dc.contributor.authorPatel, Robin
dc.contributor.authorEvans, Scott
dc.contributor.authorHill, Carol
dc.contributor.authorArias, Rebekka
dc.contributor.authorChambers, Henry F.
dc.contributor.authorFowler, Vance G.
dc.contributor.authorKreiswirth, Barry N.
dc.contributor.authorBonomo, Robert A.
dc.date.accessioned2021-02-23T14:55:06Z
dc.date.available2021-02-23T14:55:06Z
dc.date.issued2020
dc.description.abstractenglishBackground 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 USA. Methods 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 ClinicalTrials. gov, number NCT03646227. Findings 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 died. Interpretation 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 Enterobacterales.eng
dc.format.mimetypeapplication/pdf
dc.identifier.doihttps://doi.org/10.1016/s1473-3099(19)30755-8
dc.identifier.instnameinstname:Universidad El Bosquespa
dc.identifier.issn1474-4457
dc.identifier.reponamereponame:Repositorio Institucional Universidad El Bosquespa
dc.identifier.repourlrepourl:https://repositorio.unbosque.edu.co
dc.identifier.urihttps://hdl.handle.net/20.500.12495/5419
dc.language.isoeng
dc.publisherElsevier Ltd.spa
dc.publisher.journalThe Lancet Infectious Diseasesspa
dc.relation.ispartofseriesThe Lancet Infectious Diseases, 1474-4457, Vol. 20, Nro. 6, 2020, p. 731–741spa
dc.relation.urihttps://www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30755-8/fulltext
dc.rights.accessrightshttps://purl.org/coar/access_right/c_abf2
dc.rights.accessrightsinfo:eu-repo/semantics/openAccess
dc.rights.accessrightsAcceso abierto
dc.rights.creativecommons2020
dc.rights.localAcceso abiertospa
dc.subject.keywordsProspective cohort studyspa
dc.subject.keywordsCohort studyspa
dc.subject.keywordsImmunologyspa
dc.titleMolecular and clinical epidemiology of carbapenem-resistant Enterobacterales in the USA (CRACKLE-2): a prospective cohort studyspa
dc.title.translatedMolecular and clinical epidemiology of carbapenem-resistant Enterobacterales in the USA (CRACKLE-2): a prospective cohort studyspa
dc.type.coarhttps://purl.org/coar/resource_type/c_6501
dc.type.driverinfo:eu-repo/semantics/article
dc.type.hasversioninfo:eu-repo/semantics/publishedVersion
dc.type.localArtículo de revista

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