Incidence of a subsequent carbapenem-resistant Enterobacteriaceae infection after previous colonisation or infection: a prospective cohort study

•This study aimed to characterise the incidence of subsequent carbapenemase-producing, carbapenem-resistant Enterobacteriaceae (CP-CRE) infective episodes in individuals with prior CP-CRE colonisation and/or infection, and identify predictors of these subsequent CP-CRE infections.•Sixteen of 151 patients (10.6%) who entered the follow-up period had a subsequent CP-CRE-associated infection [median time to a subsequent infective episode was 24.5 days (12–105 days)].•Patients who had their first CP-CRE isolated either from intra-abdominal or respiratory tract sources were significantly more likely to develop a subsequent infection (OR 12.9; 95% CI 3.5–47.4; P < 0.01).•Two of 101 (2.0%) patients with initial positive stool screening specimens developed subsequent intra-abdominal infections.•Exposure to carbapenems (OR 2.9; 95% CI 1.0–8.5; P = 0.04), Klebsiella spp. (OR 2.9; 95% CI 1.1–7.6; P = 0.03), underlying end-stage renal failure on chronic dialysis (OR 4.2; 95% CI 1.3–12.9; P = 0.02), infection (versus colonisation) (OR 6.2; 95% CI 1.9–19.9; P < 0.01), OXA carbapenemase (OR 6.4; 95% CI 1.6–25.1; P = 0.02), respiratory tract (OR 7.6; 95% CI 1.5–37.5; P = 0.03), and intra-abdominal infections (OR 15.3; 95% CI 2.3–100.3; P < 0.01) in the index episode were predictors of subsequent CP-CRE infection on univariate analysis (Table 3). In patients with a history of carbapenemase-producing, carbapenem-resistant Enterobacteriaceae (CP-CRE), the need for CP-CRE targeted treatment in subsequent sepsis episodes is unclear. This study aimed to characterise the incidence of subsequent CP-CRE infective episodes in individuals with prior CP-CRE colonisation and/or infection, and identify predictors for these subsequent CP-CRE infections. All adult inpatients with CP-CRE detected from any site between June 2012 and May 2014 at a tertiary-care hospital were prospectively followed for two years to assess for any subsequent CP-CRE infections. Potential factors to which patients were exposed during the follow-up period were collected from medical records and analysed. A total of 171 patients were enrolled. Of 151 patients who entered the follow-up period, 16 (10.6%) developed a subsequent CP-CRE infection. The median time to a subsequent infective episode was 24.5 days (12–105 days). The type of carbapenemase was highly conserved within index and subsequent paired episodes (16 of 17 pairs). Patients with first CP-CRE isolated from intra-abdominal or respiratory sources were ≥