{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T13:27:03Z","timestamp":1790083623013,"version":"4.0.1"},"reference-count":43,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2020,7,17]],"date-time":"2020-07-17T00:00:00Z","timestamp":1594944000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Risk factors and outcomes associated with carbapenem-resistant Enterobacteriaceae (CRE) acquisitions are derived primarily from cohorts consisting of carbapenemase-producing (CP) strains. Worldwide epidemiology of non-CP-CRE is evolving, but controlled epidemiological analyses are lacking.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A matched case-case-control investigation was conducted at Shamir (Assaf Harofeh) Medical Center, Israel, on November 2014\u2013December 2016. Noncarbapenemase-producing CRE (as defined by the US Clinical and Laboratory Standards Institute Standards) carriers were matched to patients with non-CRE Enterobacterales and to uninfected controls (1:1:1 ratio). Matched and nonmatched multivariable regression models were constructed to analyze predictors for acquisition and the independent impact of carriage on multiple outcomes, respectively. Representative isolates were whole genome sequenced and analyzed for resistome and phylogeny.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Noncarbapenemase-producing CRE carriers (n\u2005=\u2005109) were matched to the 2 comparative groups (overall n\u2005=\u2005327). Recent exposure to antibiotics (but not specifically to carbapenems), prior intensive care unit admission, and chronic skin ulcers were all independent predictors for non-CP-CRE acquisition. Acquisitions were almost exclusively associated with asymptomatic carriage (n\u2005=\u2005104), and despite strong associations per univariable analyses, none were independently associated with worse outcomes. Genomic analyses of 13 representative isolates revealed polyclonality, confirmed the absence of carbapenemases, but confirmed the coexistence of multiple other genes contributing to carbapenem-resistance phenotype (multiple beta-lactamases and efflux pumps).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Noncarbapenemase-producing CRE acquisitions are primarily associated with asymptomatic carriage, specifically among prone populations with extensive recent exposures to antibiotics. The prevalent mode of acquisition is \u201cemergence of resistance\u201d (not \u201cpatient-to-patient transmission\u201d), and therefore the role of stewardship interventions in reducing the spread of these therapeutically challenging pathogens should be further explored.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofaa299","type":"journal-article","created":{"date-parts":[[2020,7,17]],"date-time":"2020-07-17T14:02:33Z","timestamp":1594994553000},"source":"Crossref","is-referenced-by-count":35,"title":["The Clinical and Molecular Epidemiology of Noncarbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae: A Case-Case-Control Matched Analysis"],"prefix":"10.1093","volume":"7","author":[{"given":"Ruth","family":"Bouganim","sequence":"first","affiliation":[{"name":"Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liana","family":"Dykman","sequence":"additional","affiliation":[{"name":"Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Fakeh","sequence":"additional","affiliation":[{"name":"Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yair","family":"Motro","sequence":"additional","affiliation":[{"name":"Department of Health Systems Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rivka","family":"Oren","sequence":"additional","affiliation":[{"name":"Department of Health Systems Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Daniel","sequence":"additional","affiliation":[{"name":"Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tzilia","family":"Lazarovitch","sequence":"additional","affiliation":[{"name":"Clinical Microbiology Laboratory, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronit","family":"Zaidenstein","sequence":"additional","affiliation":[{"name":"Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel"},{"name":"Department of Medicine A, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Moran-Gilad","sequence":"additional","affiliation":[{"name":"Department of Health Systems Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dror","family":"Marchaim","sequence":"additional","affiliation":[{"name":"Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel"},{"name":"Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,7,17]]},"reference":[{"key":"2020082210165625000_CIT0001","doi-asserted-by":"crossref","first-page":"1804","DOI":"10.1056\/NEJMra0904124","article-title":"Hospital-acquired infections due to Gram-negative bacteria","volume":"362","author":"Peleg","year":"2010","journal-title":"N Engl J Med"},{"key":"2020082210165625000_CIT0002","author":"World Health Organization"},{"key":"2020082210165625000_CIT0003","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1086\/595011","article-title":"Bad bugs, no drugs: no ESKAPE! 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