@article{3342282,
    title = "Risk factors for infections caused by carbapenem-resistant Enterobacterales: an international matched case-control-control study (EURECA)",
    author = "Pérez-Galera, S. and Bravo-Ferrer, J.M. and Paniagua, M. and Kostyanev, T. and de Kraker, M.E.A. and Feifel, J. and Sojo-Dorado, J. and Schotsman, J. and Cantón, R. and Daikos, G.L. and Carevic, B. and Dragovac, G. and Tan, L.K. and Raka, L. and Hristea, A. and Viale, P. and Akova, M. and Reguera, J.M. and Valiente de Santis, L. and Torre-Cisneros, J. and Cano, Á. and Roilides, E. and Radulovic, L. and Kirakli, C. and Shaw, E. and Falagas, M.E. and Pintado, V. and Goossens, H. and Bonten, M.J. and Gutiérrez-Gutiérrez, B. and Rodriguez-Baño, J. and de la Serna, A. and Monteau, S. and Palomo, V. and Soriano, E. and Gutierrez, D. and Moreno, E. and Palacios, Z. and Morales, I. and Maldonado, N. and Ciezar, A.P. and Ruiz Mesa, J.D. and Diaz, B.S. and Gomez, I.M. and Camacho, I.P. and Frutos-Adame, A. and Guzman-Puche, J. and Gracia-Ahufinger, I. and Perez-Nadales, E. and Torre-Gimenez, J. and Pyrpasopoulou, A. and Iosifidis, E. and Chorafa, E. and Radovanovic, I. and Petrovic, S. and Cvetkovi, S. and Melentijevic, S.-S. and Bicmen, C. and Senol, G. and Tubau, F. and Camara, J. and Gumucio, V.D. and Bassoulis, D. and Deliolanis, J. and Pitiriga, V.C. and Triarides, N. and Argiti, E. and Legakis, N.J. and Margarita, K. and Gijón-Cordero, D. and Ruiz-Garbajosa, P. and Bartoloni, A. and Rossolini, G.M. and Florescu, S.-A. and Nica, M. and Benea, S. and Talapan, D. and Medić, D. and Prijić, S.M. and Caballero, M.C. and Parra Ramírez, L.M. and Korten, V. and Bilgin, H. and Dalekos, G.N. and Stefos, A. and Spyridis, N. and Michos, A. and De Rosa, F.G. and Cavallo, R. and Petrosillo, N. and Dicaro, A. and Landini, M.P. and Ciofi degli Atti, M.L. and Masanovic, M. and Matkovic, D. and Tsiodras, S. and Blasi, F. and Di pasquale, M. and Viscoli, C. and Vata, A. and Dorneanu, O. and Kapisyzi, P. and Vince, A. and Tsigou, E. and Maltezos, E. and Komnos, A. and Gogos, C. and Franzetti, F. and Antonelli, M. and Lupse, M. and Corneci, D. and Tomescu, D. and Georgescu, A. and Bukarica, L. and Mitrović, G. and Krstić, N.L. and Kurti, A. and Díaz-Pollán, B. and Sabater, J.O. and Muñoz, P. and Azap, A. and Sancak, B. and Sahin, A. and Akalin, H. and the COMBACTE-CARE-EURECA Team",
    journal = "ECLINICALMEDICINE",
    year = "2023",
    volume = "57",
    publisher = "Elsevier Ireland Ltd",
    doi = "10.1016/j.eclinm.2023.101871",
    keywords = "beta lactam antibiotic;  carbapenem derivative;  metallo beta lactamase;  oxyimino beta lactam;  piperacillin plus tazobactam;  quinoline derived antiinfective agent;  unclassified drug, abdominal infection;  adult;  aged;  Article;  bacteremia;  bacterial colonization;  bladder catheterization;  carbapenem-resistant Enterobacteriaceae;  case control study;  chronic kidney failure;  cohort analysis;  controlled study;  Enterobacter cloacae;  Enterobacteriaceae infection;  Escherichia coli;  female;  human;  incidence;  Klebsiella pneumoniae;  length of stay;  major clinical study;  male;  nonhuman;  pneumonia;  prospective study;  risk assessment;  risk factor;  urinary tract infection",
    abstract = "Background: Data on risk factors for carbapenem-resistant Enterobacterales (CRE) with wider applicability are needed to inform preventive measures and efficient design of randomised trials. Methods: An international matched case-control-control study was performed in 50 hospitals with high CRE incidence from March 2016 to November 2018 to investigate different aspects of infections caused by CRE (NCT02709408). Cases were patients with complicated urinary tract infection (cUTI), complicated intraabdominal (cIAI), pneumonia or bacteraemia from other sources (BSI-OS) due to CRE; control groups were patients with infection caused by carbapenem-susceptible Enterobacterales (CSE), and by non-infected patients, respectively. Matching criteria included type of infection for CSE group, ward and duration of hospital admission. Conditional logistic regression was used to identify risk factors. Findings: Overall, 235 CRE case patients, 235 CSE controls and 705 non-infected controls were included. The CRE infections were cUTI (133, 56.7%), pneumonia (44, 18.7%), cIAI and BSI-OS (29, 12.3% each). Carbapenemase genes were found in 228 isolates: OXA-48/like, 112 (47.6%), KPC, 84 (35.7%), and metallo-β-lactamases, 44 (18.7%); 13 produced two. The risk factors for CRE infection in both type of controls were (adjusted OR for CSE controls; 95% CI; p value) previous colonisation/infection by CRE (6.94; 2.74–15.53; <0.001), urinary catheter (1.78; 1.03–3.07; 0.038) and exposure to broad spectrum antibiotics, as categorical (2.20; 1.25–3.88; 0.006) and time-dependent (1.04 per day; 1.00–1.07; 0.014); chronic renal failure (2.81; 1.40–5.64; 0.004) and admission from home (0.44; 0.23–0.85; 0.014) were significant only for CSE controls. Subgroup analyses provided similar results. Interpretation: The main risk factors for CRE infections in hospitals with high incidence included previous colonization, urinary catheter and exposure to broad spectrum antibiotics. Funding: The study was funded by the e Medicines Initiative Joint Undertaking (https://www.imi.europa.eu/) under Grant Agreement No. 115620 (COMBACTE-CARE). © 2023 The Author(s)"
}