Epidemiology of and risk factors for mortality due to carbapenemase-producing organisms (CPO) in healthcare facilities.

BACKGROUND Carbapenemase-producing organisms (CPO) have been largely responsible for the extensive spread of carbapenem resistance, and their prevalence is increasing in many parts of the world. AIM To evaluate clinical and molecular epidemiology and mortality associated with CPO among patients. METHODS All CPO from clinical and long-term healthcare surveillance cultures across Scotland in 2003-2017 were reviewed retrospectively. Polymerase chain reaction was used to detect genes coding for carbapenemases. A generalized linear mixed model was used to identify risk factors for mortality. FINDINGS In total, 290 individuals with CPO were identified. The overall incidence increased over time (P 60 years [adjusted odds ratio (aOR) 3.36, 95% confidence interval (CI) 1.06-10.63; P=0.033], presence of non-fermenters (aOR 4.88, 95% CI 1.64-14.47; P=0.005), and systemic infection or organ failure (aOR 4.21, 95% CI 1.38-12.81; P=0.032) were independently associated with 30-day mortality. CONCLUSION The incidence of CPO in Scotland is low but increasing. Awareness is required that inpatients aged >60 years, patients with systemic infection or organ failure, and patients presenting with non-fermenters are at higher risk of death from CPO.