Send to

Choose Destination
Eur J Clin Microbiol Infect Dis. 2019 Feb;38(2):383-393. doi: 10.1007/s10096-018-3438-9. Epub 2018 Nov 28.

Risk factors for carbapenem-resistant Enterobacteriaceae infections: a French case-control-control study.

Author information

Service de Microbiologie, Hôpital Beaujon, AP-HP, F-92110, Clichy, France.
INSERM and University Paris Diderot, IAME, UMR 1137, 16 rue Henri Huchard, F-75018, Paris, France.
Department of Epidemiology, Biostatistic and Clinical Research, Bichat Hospital, AP-HP, F-75018, Paris, France.
INSERM, CIC-EC 1425, Bichat Hospital, AP-HP, F-75018, Paris, France.
INSERM and University Paris Diderot, IAME, UMR 1137, 16 rue Henri Huchard, F-75018, Paris, France.
Centre d'Immunologie et des Maladies Infectieuses, CIMI-Paris, Team E13 (Bacteriology), CR7, INSERM, U1135, Sorbonne Université, F-75013, Paris, France.
Bacteriology and Hygiene, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, F-75013, Paris, France.


This study aimed to assess characteristics associated with infections due to carbapenem-resistant Enterobacteriaceae (CRE), producing (CPE) or not producing (non-CPE) carbapenemase, among hospitalised patients in 2014-2016 in France. Case-patients with CRE were compared to two control populations. In multivariate analysis comparing 160 CRE cases to 160 controls C1 (patients with a clinical sample positive for carbapenem-susceptible Enterobacteriaceae), five characteristics were linked to CRE: male gender (OR = 1.9; 95% CI = 1.3-3.4), travel in Asia (OR = 10.0; 95% CI = 1.1-91.2) and hospitalisation in (OR = 2.4; 95% CI = 1.3-4.4) or out of (OR = 4.4; 95% CI = 0.8-24.1) France in the preceding 12 months, infection in the preceding 3 months (OR = 3.0; 95% CI = 1.5-5.9), and antibiotic receipt between admission and inclusion (OR = 1.9; 95% CI = 1.0-3.3). In multivariate analysis comparing 148 CRE cases to 148 controls C2 [patients with culture-negative sample(s)], four characteristics were identified: prior infection (OR = 3.3; 95% CI = 1.6-6.8), urine drainage (OR = 3.0; 95% CI = 1.5-6.1) and mechanical ventilation (OR = 3.7; 95% CI = 1.1-13.0) during the current hospitalisation, and antibiotic receipt between admission and inclusion (OR = 6.6; 95% CI = 2.8-15.5). Univariate analyses comparing separately CPE cases to controls (39 CPE vs C1 and 36 CPE vs C2) and non-CPE cases to controls (121 non-CPE vs C1 and 112 non-CPE vs C2), concomitantly with comparison of CPE to non-CPE cases showed that only CPE cases were at risk of previous travel and hospitalisation abroad. This study shows that, among CRE, risk factors are different for CPE and non-CPE infection, and suggests that question patients about their medical history and lifestyle should help for early identification of patients at risk of CPE among patients with CRE.


Carbapenem-resistant Enterobacteriaceae (CRE); Carbapenemase-producing Enterobacteriaceae (CPE); Case-control-control study; Multicentre study; Risk factors

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center