Time to intestinal clearance of carbapenemase- producing Enterobacterales in hospital patients: a longitudinal retrospective observational cohort study

Background: Intestinal clearance of carbapenemase-producing Enterobacterales (CPE-IC) is a cornerstone to discontinue isolation precautions for CPE patients in hospitals. This study aimed to evaluate the time to spontaneous CPE-IC and identify its potential associated risk factors.Methods: This retrospective cohort study was carried out between January 2018 and September 2020 on all patients in a 3200-bed teaching referral hospital with confirmed CPE intestinal carriage. CPE-IC was defined as at least three consecutive CPE-negative rectal swab cultures without a subsequent positive result. A survival analysis was performed to determine the median time to CPE-IC. A multivariate Cox model was implemented to explore the factors associated with CPE-IC.Results: A total of 110 patients were positives for CPE, of whom 27 (24.5%) achieved CPEIC. Median time to CPE-IC was 698 days. Univariate analysis showed that female sex (P=0.046), multiple CPE-species in index cultures (P=0.005), Escherichia coli or Klebsiella spp. (P=0.001 and P=0.028, respectively) were significantly associated with the time to CPE-IC. Multivariate analysis highlighted that identification of E. coli carbapenemase-producing or CPEs harbouring ESBL genes in index culture extended the median time to CPE-IC, respectively (adjusted hazard ratio (aHR) = 0.13 (95% confidence interval: 0.04-0.45]; P=0.001 and aHR = 0.34 (95% confidence interval: 0.12-0.90);Conclusion: Intestinal decolonization of CPE can take several months to years to occur. Carbapenemase-producing E. coli are likely to play a key role in delaying intestinal

Automated summary

This study aimed to evaluate the time to spontaneous CPE-IC and identify its potential associated risk factors. The median time to CPE-IC was 698 days. Female sex, multiple CPE-species, and E. coli or Klebsiella spp. infections were significantly associated with the time to CPE-IC. The presence of E. coli carbapenemase-producing or ESBL genes in index culture extended the median time to CPE-IC.