Nationwide analysis of a large, geographically diverse cohort of adults in the USA suggests increased risk for hospital-acquired carbapenem-resistant enterobacterales bloodstream infections among racial and ethnic minorities may be due in part to hospitalisations for underlying comorbidities and associated with racial and biological sex inequities
**ECCMID has now changed name to ESCMID Global, please credit ESCMID Global Congress (Barcelona, Spain, 27-30 April) in all future stories**
New research being presented at this year's ESCIMD Global Congress (formerly ECCMID) in Barcelona, Spain (27-30 April), finds that the odds of death in Black women with a bloodstream infection (BSI) caused by carbapenem-resistant enterobacterales (CRE)—a family of the world's most intractable drug-resistant bacteria—was twice that of Black men or White women even after adjusting for age, BSI source, liver disease, hospital onset, race and gender and the race-gender interaction.
"These findings are deeply troubling," says lead author Dr Felicia Ruffin from Duke University School of Medicine in Durham, North Carolina, USA. "Studies are rare that describe these disparities, and our analyses found that it is being both female and Black that is associated with an increased risk of dying."
"Our study did not address the reasons for these disparities, but differences in comorbid conditions affecting the immune response emerged as a possibility for the differences in the outcomes. Additional research is needed to uncover the social determinants of health outcomes. Barriers to access to medical care, socioeconomic status, differences in antibiotic use, and health literacy about antimicrobial-resistance (AMR) may also contribute to these disparities, all of which can be associated with racial and biological sex inequities."
The US Centers for Disease Control and Prevention (CDC) estimates that 2.8 million people become infected each year with antibiotic-resistant bacteria, resulting in at least 35,000 deaths [1]. Enterobacterales are the largest group of disease-causing bacteria in humans. Carbapenem-resistant Enterobacterales (CREs) are resistant to commonly prescribed antibiotics called carbapenems, which are considered the drugs of last resort for treating severe infections. In the USA, about 2-3% of Enterobacterales associated with healthcare infections are resistant to carbapenems [2].
Infections caused by these organisms are associated with high death rates among hospitalised patients, up to 50% in some studies [3]. However, the relationships between race and sex on clinical outcomes after bloodstream infections caused by CREs are not known.
To find out more, researchers examined data from 362 patients treated at 29 US hospitals in 17 states including the District of Columbia (DC)for bloodstream infections caused by CDC-defined CRE (in vitro resistance to one or more carbapenems – including ertapenem – without any requirement for cephalosporin resistance) between April 2016 and November 2019.
All patients were enrolled in the CRACKLE-2 study (the second Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacteriaceae)—a prospective, multicentre, cohort study with consecutive enrolment of hospitalised patients [3].
