Epidemiology of carbapenem-resistant enterobacteriaceae in 7 US communities, 2012-2013

Alice Y. Guh, Sandra N. Bulens, Yi Mu, Jesse T. Jacob, Jessica Reno, Janine Scott, Lucy E. Wilson, Elisabeth Vaeth, Ruth Lynfield, Kristin M. Shaw, Paula M Snippes Vagnone, Wendy M. Bamberg, Sarah J. Janelle, Ghinwa Dumyati, Cathleen Concannon, Zintars Beldavs, Margaret Cunningham, P. Maureen Cassidy, Erin C. Phipps, Nicole KenslowTatiana Travis, David Lonsway, J. Kamile Rasheed, Brandi M. Limbago, Alexander J. Kallen

Research output: Contribution to journalArticlepeer-review


IMPORTANCE: Carbapenem-resistant Enterobacteriaceae (CRE) are increasingly reported worldwide as a cause of infections with high-mortality rates. Assessment of the US epidemiology of CRE is needed to inform national prevention efforts. OBJECTIVE: To determine the population-based CRE incidence and describe the characteristics and resistance mechanism associated with isolates from 7 US geographical areas. DESIGN, SETTING, AND PARTICIPANTS: Population- and laboratory-based active surveillance of CRE conducted among individuals living in 1 of 7 US metropolitan areas in Colorado, Georgia, Maryland, Minnesota, New Mexico, New York, and Oregon. Cases of CRE were defined as carbapenem-nonsusceptible (excludingertapenem) and extended-spectrum cephalosporin-resistant Escherichia coli, Enterobacter aerogenes, Enterobactercloacae complex, Klebsiella pneumoniae, or Klebsiella oxytoca that were recovered from sterile-site or urine cultures during 2012-2013. Case records were reviewed and molecular typing for common carbapenemases was performed. EXPOSURES: Demographics, comorbidities, health care exposures, and culture source and location. MAIN OUTCOMES AND MEASURES: Population-based CRE incidence, site-specific standardized incidence ratios (adjusted for age and race), and clinical and microbiological characteristics. RESULTS: Among 599 CRE cases in 481 individuals, 520 (86.8%; 95% CI, 84.1%-89.5%) were isolated from urine and 68 (11.4%; 95% CI, 8.8%-13.9%) from blood. The median age was 66 years (95% CI, 62.1-65.4 years) and 284 (59.0%; 95% CI, 54.6%-63.5%) were female. The overall annual CRE incidence rate per 100 000 population was 2.93 (95% CI, 2.65-3.23). The CRE standardized incidence ratio was significantly higher than predicted for the sites in Georgia (1.65 [95% CI, 1.20-2.25]; P

Original languageEnglish (US)
Pages (from-to)1479-1487
Number of pages9
JournalJournal of the American Medical Association
Issue number14
StatePublished - Oct 13 2015
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)


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