Observational studyThe Lancet. Infectious diseases2020
Molecular and clinical epidemiology of carbapenem-resistant Enterobacterales in the USA (CRACKLE-2): a prospective cohort study.
Observational study in The Lancet. Infectious diseases, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT03646227 (Multi-Drug Resistant Organism Network - MDRO Network), which is not on this map. Cited by 224 papers, 1 of them a synthesis 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.
Multi-Drug Resistant Organism Network - MDRO Network
Who cites it
224 citing papers in PubMed, 1 synthesis or guideline pooled it, 317 citations in OpenAlex.
- Efficacy and safety of imipenem/cilastatin/relebactam (IMI/CS/REL): a meta-analysis of randomized controlled clinical trials.BMC infectious diseases · 2025Pooled it
- Stepwise phage resistance and collateral phage susceptibility inEmerging microbes & infections · 2026Article
- Article
- A rapid, inexpensive diagnostic for bacterial pathogen and resistance detection in resource-limited settings.Science advances · 2026Article
- Global epidemiology of carbapenem-resistantJAC-antimicrobial resistance · 2026Review
- The global epidemiology and treatment of metallo-β-lactamase-producing gram-negative pathogens.JAC-antimicrobial resistance · 2026Review
- Article
- Comorbidities and Patient Outcomes in Carbapenem-Resistant Gram-negative Bacterial Infections.Open forum infectious diseases · 2026Article
- Article
- Distinct molecular epidemiology and outcomes of carbapenem-resistant gram-negative infections in Lebanon: insights from the MDRO network.BMC infectious diseases · 2026Article
- Genomic analysis of intrahospital transmission of carbapenem-resistant Gram-negative bacteria: a multicentre study in Japan.Microbial genomics · 2026Article
- Enhanced invasiveness promotes the dominance of a widely-distributed carbapenem-resistant virulence-plasmid-carrying Klebsiella pneumoniae sublineage.Nature communications · 2026Article
- The genomic landscape of Klebsiella pneumoniae in Russia.World journal of microbiology & biotechnology · 2026Article
- Carbapenem-resistant Enterobacterales infection at a South African paediatric hospital.BMC infectious diseases · 2026Article
- Risk factors and outcomes associated with difficult-to-treat resistance inEpidemiology and infection · 2026Article
- Nationwide spread of multidrug resistant Klebsiella pneumoniae across US communities.Nature communications · 2026Article
- Difficult-to-treat resistance (DTR), treatment, and outcomes of carbapenem-resistant Enterobacterales infections in the setting of IMP-type carbapenemase predominance in Japan.Microbiology spectrum · 2026Article
- Emergence of Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae with Penicillin-Binding Protein 3 Insertions, Taiwan, 2021.Emerging infectious diseases · 2026Review
- The ESKAPE Challenge: Understanding Resistance and Exploring Alternative Treatments.Antibiotics (Basel, Switzerland) · 2026Review
- Revisiting definitions of hypervirulent and classical Klebsiella pneumoniae through virulence factors and disease phenotype.Communications medicine · 2026Article
164 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
35 authors at 20 institutions in 5 countries.
Funding
Abstract
backgroundCarbapenem-resistant Enterobacterales (CRE) are a global threat. We aimed to describe the clinical and molecular characteristics of Centers for Disease Control and Prevention (CDC)-defined CRE in the USA.
methodsCRACKLE-2 is a prospective, multicentre, cohort study. Patients hospitalised in 49 US hospitals, with clinical cultures positive for CDC-defined CRE between April 30, 2016, and Aug 31, 2017, were included. There was no age exclusion. The primary outcome was desirability of outcome ranking (DOOR) at 30 days after index culture. Clinical data and bacteria were collected, and whole genome sequencing was done. This trial is registered with ClinicalTrials.gov, number NCT03646227.
findings1040 patients with unique isolates were included, 449 (43%) with infection and 591 (57%) with colonisation. The CDC-defined CRE admission rate was 57 per 100 000 admissions (95% CI 45-71). Three subsets of CDC-defined CRE were identified: carbapenemase-producing Enterobacterales (618 [59%] of 1040), non-carbapenemase-producing Enterobacterales (194 [19%]), and unconfirmed CRE (228 [22%]; initially reported as CRE, but susceptible to carbapenems in two central laboratories). Klebsiella pneumoniae carbapenemase-producing clonal group 258 K pneumoniae was the most common carbapenemase-producing Enterobacterales. In 449 patients with CDC-defined CRE infections, DOOR outcomes were not significantly different in patients with carbapenemase-producing Enterobacterales, non-carbapenemase-producing Enterobacterales, and unconfirmed CRE. At 30 days 107 (24%, 95% CI 20-28) of these patients had died.
interpretationAmong patients with CDC-defined CRE, similar outcomes were observed among three subgroups, including the novel unconfirmed CRE group. CDC-defined CRE represent diverse bacteria, whose spread might not respond to interventions directed to carbapenemase-producing Enterobacterales.
fundingNational Institutes of Health.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.