{"doi":"10.1093/jac/dkac239","title":"Characteristics of community-acquired carbapenem-resistant Enterobacterales","abstract":"BACKGROUND: Community-acquired carbapenem-resistant Enterobacterales (CA-CRE) are an important threat. METHODS: In CRACKLE-2, we defined patients with CA-CRE as admitted from home, without pre-existing conditions, and a positive culture within 48 h of admission. Healthcare-associated CRE (HA-CRE) were those with the lowest likelihood of community acquisition, not admitted from home and cultured >48 h after admission. Specific genetic markers in carbapenemase-producing Klebsiella pneumoniae were evaluated through random forest modelling. RESULTS: CA-CRE and HA-CRE were detected in 83 (10%) and 208 (26%) of 807 patients. No significant differences were observed in bacterial species or strain type distribution. K. pneumoniae (204/291, 70%) was the most common CRE species, of these 184/204 (90%) were carbapenemase producers (CPKP). The top three genetic markers in random forest models were kpi_SA15, fimE, and kpfC. Of these, kpi_SA15 (which encodes a chaperone/usher system) was positively associated (OR 3.14, 95% CI 1.13-8.87, P = 0.026), and kpfC negatively associated (OR 0.21, 95% CI 0.05-0.72, P = 0.015) with CA-CPKP. CONCLUSIONS: Ten percent of CDC-defined CRE were CA. The true proportion of CA-CRE in hospitalized patients is likely lower as patients may have had unrecorded prior healthcare exposure. The kpi_SA15 operon was associated with the CA phenotype.","journal":"Journal of Antimicrobial Chemotherapy","year":2022,"id":248170,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":31,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8939,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":232754,"name":"Courtney Luterbach","orcid":"0000-0003-2509-0842","position":1,"is_corresponding":false},{"id":871382,"name":"Weixiao Dai","orcid":"0000-0002-1990-9244","position":2,"is_corresponding":false},{"id":234480,"name":"Lauren Komarow","orcid":null,"position":3,"is_corresponding":false},{"id":234483,"name":"Michelle Earley","orcid":null,"position":4,"is_corresponding":false},{"id":234481,"name":"Gregory Weston","orcid":null,"position":5,"is_corresponding":false},{"id":618259,"name":"Erica Herc","orcid":"0000-0002-9069-6659","position":6,"is_corresponding":false},{"id":232744,"name":"Jesse T. 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