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Open Forum Infect Dis. 2017 Jul 27;4(3):ofx157. doi: 10.1093/ofid/ofx157. eCollection 2017 Summer.

A Prospective Observational Study of the Epidemiology, Management, and Outcomes of Skin and Soft Tissue Infections Due to Carbapenem-Resistant Enterobacteriaceae.

Author information

1
Department of Medicine, University of Michigan, Ann Arbor; Departments of.
2
Infectious Diseases and.
3
Laboratory Medicine, Cleveland Clinic, Ohio.
4
Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Ohio.
5
Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio.
6
Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio.
7
Department of Internal Medicine, Northeast Ohio Medical University, Rootstown.
8
Division of Infectious Diseases, Akron General Medical Center, Ohio; Departments of.
9
Medicine.
10
Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pennsylvania.
11
Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts.
12
Division of Infectious Diseases and.
13
Duke Clinical Research Institute, Duke University, Durham, North Carolina.
14
Pharmacology.
15
Molecular Biology and Microbiology.
16
Biochemistry, and.
17
Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, Ohio.
18
Division of Infectious Diseases, University of North Carolina, Chapel Hill.

Abstract

BACKGROUND:

This study was performed to characterize the epidemiology, management, and outcomes of skin and soft tissue infection (SSTI) and colonization due to carbapenem-resistant Enterobacteriaceae (CRE).

METHODS:

Patients from the Consortium on Resistance Against Carbapenem in Klebsiella and Other Enterobacteriaceae (CRACKLE-1) from December 24, 2011 to October 1, 2014 with wound cultures positive for CRE were included in the study. Predictors of surgical intervention were analyzed. Molecular typing of isolates was performed using repetitive extragenic palindromic polymerase chain reaction (PCR). Carbapenemase genes were detected using PCR.

RESULTS:

One hundred forty-two patients were included: 62 had SSTI (44%) and 56% were colonized. Mean age was 61 years, and 48% were male: median Charlson score was 3 (interquartile range, 1-5). Forty-eight percent of patients were admitted from long-term care facilities (LTCFs), and 31% were from the community. Two strain types (ST258A and ST258B) were identified (73% of 45 tested). Carbapenemase genes were detected in 40 of 45 isolates (blaKPC-3 [47%], blaKPC-2 [42%]). Sixty-eight patients (48%) underwent surgical intervention, 63% of whom had SSTI. Patients admitted from LTCFs were less likely to undergo surgical intervention (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.18-0.71). In multivariable analysis, among patients with SSTI, those admitted from LTCFs were less likely to undergo debridement (OR, 0.18; 95% CI, 0.04-0.93).

CONCLUSIONS:

Patients admitted from LTCFs with CRE SSTI were less likely to undergo surgical intervention. Sixteen percent of the patients died, and approximately 50% of survivors required more intensive care upon discharge. These findings suggest a unique, impactful syndrome within the CRE infection spectrum. Further studies are needed to assess the role of surgical debridement in management of CRE-SSTI, particularly among LTCF residents.

KEYWORDS:

Klebsiella pneumoniae; ST258; carbapenem-resistant Enterobacteriaceae; surgical site infections; wound infection

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