Trial reportCritical care medicine2015
The association between colonization with carbapenemase-producing enterobacteriaceae and overall ICU mortality: an observational cohort study.
Trial report in Critical care medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
50 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- A comprehensive evaluation of risk factors for mortality, infection and colonization associated with CRGNB in adult solid organ transplant recipients: a systematic review and meta-analysis.Annals of medicine · 2024Pooled it
- Antibiotic-resistant pathogens in different patient settings and identification of surveillance gaps in Switzerland - a systematic review.Epidemiology and infection · 2019Pooled it
- Multidrug-resistant gram-negative bacteria in Spanish ICU patients: clinical and microbiological characterization (MURAN-UCI Project).Microbiology spectrum · 2026Article
- Risk factors for carbapenem-resistantJAC-antimicrobial resistance · 2026Article
- Early prediction of colonization by carbapenemase-producing enterobacterales at ICU admission using machine learning.Scientific reports · 2026Article
- Clinical Burden of Carbapenemase-Producing Enterobacterales in Spain: A Multicenter Retrospective Study from Five Hospitals.Infection and drug resistance · 2026Article
- Carbapenem-resistant Enterobacterales infection and colonization in patients with severe burns: a retrospective cohort study in a single burn center.Antimicrobial resistance and infection control · 2025Article
- Impact of XpertFrontiers in cellular and infection microbiology · 2025Observational
- The underestimated burden of postoperative pulmonary complications in emergency laparotomy: a propensity score-matched analysis.Frontiers in medicine · 2025Article
- Intestinal dysbiosis in critically ill patients: a case-control study ofFrontiers in medicine · 2025Article
- Relationship between SARS-CoV-2 infection and ICU-acquired candidemia in critically ill medical patients: a multicenter prospective cohort study.Critical care (London, England) · 2024Article
- Accuracy of Xpert Carba-R Assay for the Diagnosis of Carbapenemase-producing Organisms from Rectal Swabs in Asia: a Diagnostic Meta-analysis.Indian journal of microbiology · 2024Article
- Carbapenem-producingFrontiers in cellular and infection microbiology · 2024Article
- Carbapenem- and colistin-resistantFrontiers in microbiology · 2024Article
- Antimicrobial Multidrug Resistance: Clinical Implications for Infection Management in Critically Ill Patients.Microorganisms · 2023Review
- Predictors of bacteremia and death, including immune status, in a large single-center cohort of unvaccinated ICU patients with COVID-19 pneumonia.European journal of medical research · 2023Article
- Article
- In-hospital mortality and one-year survival of critically ill patients with cancer colonized or not with carbapenem-resistant gram-negative bacteria or vancomycin-resistant enterococci: an observational study.Antimicrobial resistance and infection control · 2023Observational
- Gut colonisation with multidrug-resistant Klebsiella pneumoniae worsens Pseudomonas aeruginosa lung infection.Nature communications · 2023Article
- Ceftazidime/Avibactam, Polymyxin or Tigecycline as a Rescue Strategy for the Treatment of Carbapenem-ResistantInfection and drug resistance · 2023Article
Corrections and comments
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Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesInfections caused by carbapenemase-producing Enterobacteriaceae are increasing worldwide, especially in ICUs, and have been associated with high mortality rates. However, unequivocally demonstrating causality of such infections to death is difficult in critically ill patients because of potential confounding and competing events. Here, we quantified the effects of carbapenemase-producing Enterobacteriaceae carriage on patient outcome in two Greek ICUs with carbapenemase-producing Enterobacteriaceae endemicity.
designObservational cohort study.
settingTwo ICUs with carbapenemase-producing Enterobacteriaceae endemicity. PATIENTS: Patients admitted to the ICU with an expected length of ICU stay of at least 3 days were included.
interventionsNone. MEASUREMENTS AND MAIN
resultsCarbapenemase-producing Enterobacteriaceae colonization was established through screening in perineum swabs obtained at admission and twice weekly and inoculated on chromogenic plates. Detection of carbapenemases was performed phenotypically, with confirmation by polymerase chain reaction. Risk factors for ICU mortality were evaluated using cause-specific hazard ratios and subdistribution hazard ratios, with carbapenemase-producing Enterobacteriaceae colonization as time-varying covariate. One thousand seven patients were included, 36 (3.6%) were colonized at admission, and 96 (9.5%) acquired carbapenemase-producing Enterobacteriaceae colonization during ICU stay, and 301 (29.9%) died in ICU. Of 132 carbapenemase-producing Enterobacteriaceae isolates, 125 (94.7%) were Klebsiella pneumoniae and 74 harbored K. pneumoniae carbapenemase (56.1%), 54 metallo-β-lactamase (40.9%), and four both (3.0%). Carbapenemase-producing Enterobacteriaceae colonization was associated with a statistically significant increase of the subdistribution hazard ratio for ICU mortality (subdistribution hazard ratio=1.79; 95% CI, 1.31-2.43), not explained by an increased daily hazard of dying (cause-specific hazard ratio for death=1.02; 95% CI, 0.74-1.41), but by an increased length of stay (cause-specific hazard ratio for discharge alive=0.73; 95% CI, 0.51-0.94). Other risk factors in the subdistribution hazard model were Acute Physiology and Chronic Health Evaluation II score (subdistribution hazard ratio=1.13; 95% CI, 1.11-1.15), female gender (subdistribution hazard ratio=1.29; 95% CI, 1.02-1.62), presence of solid tumor (subdistribution hazard ratio=1.54; 95% CI, 1.15-2.06), hematopoietic malignancy (subdistribution hazard ratio=1.61; 95% CI, 1.04-2.51), and immunodeficiency (subdistribution hazard ratio=1.59; 95% CI, 1.11-2.27).
conclusionsPatients colonized with carbapenemase-producing Enterobacteriaceae have on average a 1.79 times higher hazard of dying in ICU than noncolonized patients, primarily because of an increased length of stay.
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