{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T21:33:22Z","timestamp":1791408802557,"version":"4.3.3"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T00:00:00Z","timestamp":1733097600000},"content-version":"vor","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"CIHR","doi-asserted-by":"publisher","award":["159503"],"award-info":[{"award-number":["159503"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011593","name":"ICES","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100011593","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,11,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Antimicrobial-resistant (AMR) pathogens represent an ongoing global health burden. Colonization is often a prerequisite for infection, but the risk of infection after AMR colonization is not well understood. Using population-level health administrative data, we sought to investigate the risk of infection with the same AMR organism after detection of colonization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective population-wide cohort study among residents of Ontario, Canada, over a 5-year period to determine the risk of infection after detection of colonization with the following AMR pathogens: methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, extended-spectrum \u03b2-lactamase\u2013producing Enterobacterales, and carbapenemase-producing Enterobacterales. We also examined the effects of age, sex, and health care setting of colonization detection on subsequent infection risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 69 998 individuals with a positive AMR pathogen surveillance test result during the study period, 15.6% of which subsequently developed a sterile or nonsterile site infection within a median 57 days (IQR, 11\u2013228). Infection rates varied among organisms: 18.3% for methicillin-resistant S aureus within a median 57 days (IQR, 10\u2013239), 2.8% for vancomycin-resistant Enterococcus within a median 37 days (IQR, 11\u2013119), 21.5% for extended-spectrum \u03b2-lactamase\u2013producing Enterobacterales within a median 71 days (IQR, 18\u2013231), and 20.3% for carbapenemase-producing Enterobacterales within a median 10 days (IQR, 3\u201342). A positive surveillance test result detected in a hospital was associated with increased infection risk after colonization as compared with the community setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The overall infection rate after colonization with an AMR pathogen was high for most organisms, highlighting the importance of detecting colonization from both an infection control and empiric antibiotic selection perspective.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofae712","type":"journal-article","created":{"date-parts":[[2024,11,28]],"date-time":"2024-11-28T23:24:39Z","timestamp":1732836279000},"source":"Crossref","is-referenced-by-count":19,"title":["Long-term Risk of Infection Among Patients Colonized With Antimicrobial-Resistant Pathogens: A Population-wide Cohort Study"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2835-6474","authenticated-orcid":false,"given":"Christina","family":"Blagojevic","sequence":"first","affiliation":[{"name":"Internal Medicine Residency Program, Faculty of Medicine, University of Toronto , Toronto, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin A","family":"Brown","sequence":"additional","affiliation":[{"name":"ICES , Toronto, Ontario ,","place":["Canada"]},{"name":"Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario ,","place":["Canada"]},{"name":"Public Health Ontario , Toronto, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Diong","sequence":"additional","affiliation":[{"name":"ICES , Toronto, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J","family":"Fridman","sequence":"additional","affiliation":[{"name":"ICES , Toronto, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennie","family":"Johnstone","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, University of Toronto , Toronto, Ontario ,","place":["Canada"]},{"name":"Department of Laboratory Medicine and Pathobiology, University of Toronto , Toronto, Ontario ,","place":["Canada"]},{"name":"Sinai Health , Toronto, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5467-6776","authenticated-orcid":false,"given":"Bradley J","family":"Langford","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario ,","place":["Canada"]},{"name":"Public Health Ontario , Toronto, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1162-8744","authenticated-orcid":false,"given":"Samantha M","family":"Lee","sequence":"additional","affiliation":[{"name":"ICES , Toronto, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek R","family":"MacFadden","sequence":"additional","affiliation":[{"name":"Ottawa Hospital Research Institute , Ottawa, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin L","family":"Schwartz","sequence":"additional","affiliation":[{"name":"ICES , Toronto, Ontario ,","place":["Canada"]},{"name":"Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario ,","place":["Canada"]},{"name":"Public Health Ontario , Toronto, Ontario ,","place":["Canada"]},{"name":"St. Joseph's Health Centre, Unity Health Toronto , Toronto, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Daneman","sequence":"additional","affiliation":[{"name":"ICES , Toronto, Ontario ,","place":["Canada"]},{"name":"Public Health Ontario , Toronto, Ontario ,","place":["Canada"]},{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, Ontario ,","place":["Canada"]},{"name":"Division of Infectious Diseases, Sunnybrook Health Sciences Centre , Toronto, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,12,2]]},"reference":[{"key":"2025091918431175800_ofae712-B1","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis","volume":"399","author":"Antimicrobial Resistance Collaborators","year":"2022","journal-title":"Lancet"},{"key":"2025091918431175800_ofae712-B2","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1086\/529381","article-title":"Strain-relatedness of methicillin-resistant Staphylococcus aureus isolates recovered from patients with repeated infection","volume":"46","author":"Huang","year":"2008","journal-title":"Clin Infect Dis"},{"key":"2025091918431175800_ofae712-B3","doi-asserted-by":"crossref","first-page":"529","DOI":"10.4065\/81.4.529","article-title":"Vancomycin-resistant enterococci: colonization, infection, detection, and treatment","volume":"81","author":"Zirakzadeh","year":"2006","journal-title":"Mayo Clin Proc"},{"key":"2025091918431175800_ofae712-B4","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1056\/NEJM200101043440102","article-title":"Nasal carriage as a source of Staphylococcus aureus bacteremia","volume":"344","author":"von Eiff","year":"2001","journal-title":"N Engl J Med"},{"key":"2025091918431175800_ofae712-B5","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1086\/589241","article-title":"Risk of infection and death due to methicillin-resistant Staphylococcus aureus in long-term carriers","volume":"47","author":"Datta","year":"2008","journal-title":"Clin Infect Dis"},{"key":"2025091918431175800_ofae712-B6","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1086\/345955","article-title":"Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization","volume":"36","author":"Huang","year":"2003","journal-title":"Clin Infect Dis"},{"key":"2025091918431175800_ofae712-B7","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.1086\/657332","article-title":"Risk of postdischarge infection with vancomycin-resistant enterococcus after initial infection or colonization","volume":"31","author":"Datta","year":"2010","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2025091918431175800_ofae712-B8","doi-asserted-by":"crossref","first-page":"e79716","DOI":"10.1371\/journal.pone.0079716","article-title":"Clinical significance of methicillin-resistant Staphylococcus aureus colonization on hospital admission: one-year infection risk","volume":"8","author":"Ridgway","year":"2013","journal-title":"PLoS One"},{"key":"2025091918431175800_ofae712-B9","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1186\/1471-2334-13-491","article-title":"Progression from new methicillin-resistant Staphylococcus aureus colonisation to infection: an observational study in a hospital cohort","volume":"13","author":"Balm","year":"2013","journal-title":"BMC Infect Dis"},{"key":"2025091918431175800_ofae712-B10","doi-asserted-by":"crossref","first-page":"6051","DOI":"10.2147\/IDR.S383688","article-title":"Bloodstream infections in patients with rectal colonization by carbapenem-resistant Enterobacteriaceae: a prospective cohort study","volume":"15","author":"Chu","year":"2022","journal-title":"Infect Drug Resist"},{"key":"2025091918431175800_ofae712-B11","doi-asserted-by":"crossref","first-page":"e0186195","DOI":"10.1371\/journal.pone.0186195","article-title":"Carbapenem-resistant Enterobacteriaceae colonization (CRE) and subsequent risk of infection and 90-day mortality in critically ill patients, an observational study","volume":"12","author":"McConville","year":"2017","journal-title":"PLoS One"},{"key":"2025091918431175800_ofae712-B12","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1007\/s10096-019-03800-y","article-title":"Incidence and risk factors for acquired colonization and infection due to extended-spectrum beta-lactamase\u2013producing gram-negative bacilli: a retrospective analysis in three ICUs with low multidrug resistance rate","volume":"39","author":"Massart","year":"2020","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2025091918431175800_ofae712-B13","doi-asserted-by":"crossref","first-page":"ofw246","DOI":"10.1093\/ofid\/ofw246","article-title":"Colonization with vancomycin-resistant enterococci and risk for bloodstream infection among patients with malignancy: a systematic review and meta-analysis","volume":"4","author":"Alevizakos","year":"2017","journal-title":"Open Forum Infect Dis"},{"key":"2025091918431175800_ofae712-B14","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1111\/1469-0691.12747","article-title":"Risk factors for carbapenem-resistant Klebsiella pneumoniae bloodstream infection among rectal carriers: a prospective observational multicentre study","volume":"20","author":"Giannella","year":"2014","journal-title":"Clin Microbiol Infect"},{"key":"2025091918431175800_ofae712-B15","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1093\/cid\/ciy507","article-title":"Methicillin-resistant Staphylococcus aureus colonization and pre- and post-hospital discharge infection risk","volume":"68","author":"Nelson","year":"2019","journal-title":"Clin Infect Dis"},{"key":"2025091918431175800_ofae712-B16","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1093\/cid\/ciy539","article-title":"Temporal dynamics and risk factors for bloodstream infection with extended-spectrum \u03b2-lactamase\u2013producing bacteria in previously-colonized individuals: national population-based cohort study","volume":"68","author":"Isendahl","year":"2019","journal-title":"Clin Infect Dis"},{"key":"2025091918431175800_ofae712-B17","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1007\/s10096-018-3275-x","article-title":"Subsequent infection with extended-spectrum \u03b2-lactamase\u2013producing Enterobacteriaceae in patients with prior infection or fecal colonization","volume":"37","author":"Lindblom","year":"2018","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2025091918431175800_ofae712-B18","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/S1473-3099(22)00811-8","article-title":"Incidence of infection with multidrug-resistant gram-negative bacteria and vancomycin-resistant enterococci in carriers: a systematic review and meta-regression analysis","volume":"23","author":"Willems","year":"2023","journal-title":"Lancet Infect Dis"},{"key":"2025091918431175800_ofae712-B19","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1016\/j.ajic.2015.12.005","article-title":"Risk of infection following colonization with carbapenem-resistant enterobactericeae: a systematic review","volume":"44","author":"Tischendorf","year":"2016","journal-title":"Am J Infect Control"},{"key":"2025091918431175800_ofae712-B20","doi-asserted-by":"crossref","first-page":"e00757-19","DOI":"10.1128\/AAC.00757-19","article-title":"The likelihood of developing a carbapenem-resistant Enterobacteriaceae infection during a hospital stay","volume":"63","author":"Tamma","year":"2019","journal-title":"Antimicrob Agents Chemother"},{"key":"2025091918431175800_ofae712-B21","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1016\/j.cmi.2019.11.025","article-title":"Infections caused by extended-spectrum \u03b2-lactamase\u2013producing Enterobacterales after rectal colonization with ESBL-producing Escherichia coli or Klebsiella pneumoniae","volume":"26","author":"Denkel","year":"2020","journal-title":"Clin Microbiol Infect"},{"key":"2025091918431175800_ofae712-B22","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1186\/s13756-019-0647-7","article-title":"Predictors for vancomycin resistant Enterococcus faecium transforming from colonization to infection: a case control study","volume":"8","author":"Chen","year":"2019","journal-title":"Antimicrob Resist Infect Control"},{"key":"2025091918431175800_ofae712-B23","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.ajic.2018.08.007","article-title":"Incidence and predictors of health care\u2013associated infections among patients colonized with carbapenem-resistant Enterobacteriaceae","volume":"47","author":"Correa","year":"2019","journal-title":"Am J Infect Control"},{"key":"2025091918431175800_ofae712-B24","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.ajic.2012.08.005","article-title":"Risk factors for development of methicillin-resistant Staphylococcus aureus infection among colonized patients","volume":"41","author":"Ramarathnam","year":"2013","journal-title":"Am J Infect Control"},{"key":"2025091918431175800_ofae712-B25","doi-asserted-by":"publisher","DOI":"10.1128\/microbiolspec.DMIH2-0026-2016","article-title":"Overview of infections in the immunocompromised host","volume":"4","author":"Dropulic","year":"2016","journal-title":"Microbiol Spectr"},{"key":"2025091918431175800_ofae712-B26","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1007\/s00134-022-06944-2","article-title":"Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study","volume":"49","author":"Tabah","year":"2023","journal-title":"Intensive Care Med"},{"key":"2025091918431175800_ofae712-B27","first-page":"217","article-title":"Vancomycin-resistant enterococcal infections: epidemiology, clinical manifestations, and optimal management","volume":"8","author":"O\u2019Driscoll","year":"2015","journal-title":"Infect Drug Resist"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofae712\/60928075\/ofae712.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/11\/12\/ofae712\/60928075\/ofae712.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/11\/12\/ofae712\/60928075\/ofae712.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T22:43:21Z","timestamp":1758321801000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofae712\/7914450"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,27]]},"references-count":27,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2024,11,27]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofae712","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,12]]},"published":{"date-parts":[[2024,11,27]]},"article-number":"ofae712"}}