Trends in community- and nosocomial-acquired infections of carbapenem resistant Enterobacteriaceae (CRE), carbapenemase producing Enterobacteriaceae (CPE) and vancomycin resistant Enterococcus (VRE): a 10-year prospective observational study

Introduction CRE, CPE, and VRE are considered significant threats to public health. Aim To determine trends of nosocomial- and community-acquired infections. Methods A 10-year prospective observational non-interventional study was conducted. We used time-series analysis to evaluate trends in infections number. Findings Infection rate (%) were: CRE 2.48 (261/10,533), CPE 1.66 (175/10,533) and VRE 15.9 (121/761). We found diminishing trends for CRE (−19% [−31;−5], P=.03) and CPE (−22% [−30;−8], P=.04) but increasing trend for VRE (+48; [CI95% 34;75], P=.001). While we found decreasing trends for CRE and CPE in emergency (−71 [−122;−25], P=.001; −45 [−92;−27], P=.001) and hospitalization (−127 [−159; −85], P=.001; −56 [−98;−216], P=.01), we found increasing trends for VRE (+148 [113;192], P=.00001; +108[65;152], P=.003). Nosocomial-infections fell in CRE (−238 [−183;−316], P=.0001) and CPE (−163 [−96; −208], P=.001), but rose in VRE (+196 [151;242], P=.0001). We showed increasing trends in ambulatory and community-acquired infections in CRE (+134% [96;189]; P=.001; +77% [52;89]; P= .002), CPE (+288 [226;343]; P=.0001; +21% [−12;46]; P=.0.08) and VRE (+348 [295;458]; P=.0001; +66% [41;83]; P=.003). Direct admitted trends rose in all groups (CRE 16% [−8; 42]; P=.05), CPE 23% [−6; 48] (P=.05) and VRE (+241 [188; 301]; P=.0001). Conclusions We found a changing infection pattern with decreasing trends in in-hospital settings and nosocomial-acquired infections but increasing ambulatory and community-acquired infections. The observed increasing-trends in direct-admitted could be explained by community-onset infections diagnosed in the hospital. Our findings highlight the need to identify CRE/CPE/VRE community-acquired infections in ambulatory and in-hospital settings.