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Mills JP, Rojas LJ, Marshall SH, et al. Risk Factors for and Mechanisms of . Open Forum Infect Dis. 2021;8(7):ofab145doi: 10.1093/ofid/ofab145.
Mills, J. P., Rojas, L. J., Marshall, S. H., Rudin, S. D., Hujer, A. M., Nayak, L., Bachman, M. A., Bonomo, R. A., & Kaye, K. S. (2021). Risk Factors for and Mechanisms of . Open forum infectious diseases, 8(7), ofab145. https://doi.org/10.1093/ofid/ofab145
Mills, John P, et al. "Risk Factors for and Mechanisms of ." Open forum infectious diseases vol. 8,7 (2021): ofab145. doi: https://doi.org/10.1093/ofid/ofab145
Mills JP, Rojas LJ, Marshall SH, Rudin SD, Hujer AM, Nayak L, Bachman MA, Bonomo RA, Kaye KS. Risk Factors for and Mechanisms of . Open Forum Infect Dis. 2021 Apr 21;8(7):ofab145. doi: 10.1093/ofid/ofab145. eCollection 2021 Jul. PMID: 34285928; PMCID: PMC8286092.
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Open Forum Infect Dis. 2021 Apr 21;8(7):ofab145. doi: 10.1093/ofid/ofab145. eCollection 2021 Jul.

Risk Factors for and Mechanisms of .

Open forum infectious diseases

John P Mills, Laura J Rojas, Steve H Marshall, Susan D Rudin, Andrea M Hujer, Luke Nayak, Michael A Bachman, Robert A Bonomo, Keith S Kaye

Affiliations

  1. Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
  2. Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
  3. Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA.
  4. Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
  5. Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA.
  6. Departments of Pharmacology, Molecular Biology and Microbiology, Biochemistry, and Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
  7. CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, Ohio, USA.

PMID: 34285928 PMCID: PMC8286092 DOI: 10.1093/ofid/ofab145

Abstract

BACKGROUND: Despite the recent emergence of plasmid-mediated colistin resistance, the epidemiology and mechanisms of colistin-resistant Enterobacterales (CORE) infections remain poorly understood.

METHODS: A case-case-control study was conducted utilizing routine clinical isolates obtained at a single tertiary health system in Ann Arbor, Michigan. Patients with CORE isolates from January 1, 2016, to March 31, 2017, were matched 1:1 with patients with colistin-susceptible Enterobacterales (COSE) and uninfected controls. Multivariable logistic regression was used to compare clinical and microbiologic features of patients with CORE and COSE to controls. A subset of available CORE isolates underwent whole-genome sequencing to identify putative colistin resistance genes.

RESULTS: Of 16 373 tested clinical isolates, 166 (0.99%) were colistin-resistant, representing 103 unique patients. Among 103 CORE isolates, 103 COSE isolates, and 102 uninfected controls, antibiotic exposure in the antecedent 90 days and age >55 years were predictors of both CORE and COSE. Of 33 isolates that underwent whole-genome sequencing, a large variety of mutations associated with colistin resistance were identified, including 4

CONCLUSIONS: Increased age and prior antibiotic receipt were associated with increased risk for patients with CORE and for patients with COSE.

© The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

Keywords: colistin resistance; enterobacterales; polymyxin resistance

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