Methods: We conducted a cross sectional study on patients admitted between 2013 and 2016, to a large tertiary care hospital in Karachi, Pakistan. Patients with CRE bacteremia were matched for the same year with patients with bacteremia due to CSE. Patients with polymicrobial blood cultures were excluded. Clinical data of these patients was obtained using a structured performa.
Results: A total of 131 patients were enrolled (65 CRE and 66 CSE). The mean age was similar in both groups ( (51.8 years and 57.1 years in CRE and CSE patients respectively). Compared to CSE, CRE bacteremia was more likely to occur in patients with Diabetes Mellitus or those with a tracheostomy (p values 0.002 and 0.014 respectively). The most common source of CRE bacteremia was central line associated (24.6 % of all cases) as opposed to urinary tract infections in those with CSE bacteremia (62.1% of all cases). Fewer patients with CRE bactermia received appropriate antibiotics (72.3 % vs 81.8%). Mortality was over three times higher in patients with CRE ( 41.5% vs 12.1%, p value = 0.001). The mortality remained higher when adjusted for the severity of illness using the PITT-bacteremia score. Increased mortality was also associated with central venous catheterization in both CRE and CSE bacteremia, while urinary catheterization and hemodialysis were associated with mortality in patients in CSE bacteremia only .While length of ICU stay was similar between the two groups, the median length of hospital stay was longer in patients with CRE (median of 8 days vs 6 days, p value = 0.021)
Conclusion: CRE bacteremia was more likely associated with central lines and led to significantly higher mortality and length of stay.
S. F. Mahmood, None