biostudies-literatureShrestha RNational Institute of Allergy and Infectious DiseasesNIAID NIH HHSNational Institutes of HealthNational Institute of General Medical SciencesNIGMS NIH HHS2763-2771https://www.ebi.ac.uk/biostudies/studies/S-EPMC9989732biostudies-literatureUnknown77(10)<h4>Background</h4>Community-acquired carbapenem-resistant Enterobacterales (CA-CRE) are an important threat.<h4>Methods</h4>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 &gt;48 h after admission. Specific genetic markers in carbapenemase-producing Klebsiella pneumoniae were evaluated through random forest modelling.<h4>Results</h4>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.<h4>Conclusions</h4>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.The Journal of antimicrobial chemotherapyCharacteristics of community-acquired carbapenem-resistant Enterobacterales.PMC9989732R01 AI134637UM1 AI104681P01 AI152999R01AI143910UM1AI104681R01 AI143910K24 AI121296R01 AI148342T32GM086330T32 GM086330Huskins WCDinh ASalata RARydell KBRevolinski SWang MHanson BHerc ERudin SDHill CDomitrovic TNPatel RKaye KSMediavilla JRPatel GEvans SOstrowsky BFries BCDoi YShropshire WChen LCober Evan Duin DFowler VGEilertson BHan JHGallagher JCDhar SManca CWeston GShrestha RAnderson DJArias CAChambers HFEarley MKim AGrant MLok JJJacob JTDai WSatlin MJHujer KMLuterbach CKreiswirth BNDesai SWong DRichter SSSalata RAbbo LMLuterbach CLKomarow LPerez FBanerjee RKalayjian RCMarshall SHTran TTGarcia-Diaz JPanesso DBonomo RAArias RHujer AMWortmann GPaterson DLFarrell JJAnderson DGarner OBMDRO InvestigatorsfalseCharacteristics of community-acquired carbapenem-resistant Enterobacterales.<h4>Background</h4>Community-acquired carbapenem-resistant Enterobacterales (CA-CRE) are an important threat.<h4>Methods</h4>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 &gt;48 h after admission. Specific genetic markers in carbapenemase-producing Klebsiella pneumoniae were evaluated through random forest modelling.<h4>Results</h4>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.<h4>Conclusions</h4>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.2022-01-01T00:00:00Z2022 Sep2026-05-28T11:25:12.933Z2025-02-19T03:26:14.359ZS-EPMC99897323617927810.1093/jac/dkac239