Eilertson, BrandonCober, EricRichter, Sandra SPerez, FedericoSalata, Robert AKalayjian, Robert CWatkins, Richard RDoi, YoheiKaye, Keith SEvans, ScottFowler, Vance GBonomo, Robert ADeHovitz, JackKreiswirth, Barryvan Duin, David2017-12-062017Eilertson, B., E. Cober, S. S. Richter, F. Perez, R. A. Salata, R. C. Kalayjian, R. R. Watkins, et al. 2017. “Carbapenem-Resistant Enterobacteriaceae Infections in Patients on Renal Replacement Therapy.” Open Forum Infectious Diseases 4 (4): ofx216. doi:10.1093/ofid/ofx216. http://dx.doi.org/10.1093/ofid/ofx216.http://nrs.harvard.edu/urn-3:HUL.InstRepos:34493318Abstract Background: Patients on chronic intermittent renal replacement therapy (RRT) are at risk for infection with carbapenem-resistant Enterobacteriaceae (CRE). However, the impact of RRT on outcomes after CRE infections remains to be defined. Here we perform a comparison of outcomes for CRE-infected patients with preserved renal function compared with CRE-infected patients on RRT. Methods: Cases and controls were defined from a prospective cohort of CRE-infected patients from the Consortium on Resistance against Carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE). Cases were defined as CRE-infected patients on RRT at hospital admission, while controls were defined as CRE-infected patients with serum creatinine <2 mg/dL and not receiving RRT at admission. Risk factors for 28-day in-hospital mortality were assessed using multivariable logistic regression. An ordinal ranking of outcomes by desirability analysis was performed. Results: Patients on RRT were more likely to have diabetes mellitus and cardiac disease than controls. Urinary sources of infection were less common in the RRT group. In RRT patients, 28-day in-hospital mortality was increased as compared with controls: 22/71 (31%) vs 33/295 (11%). RRT remained significantly associated with 28-day in-hospital mortality after adjustment for source of infection, prehospitalization origin, and severity of illness (adjusted odds ratio, 2.27; 95% confidence interval [CI], 1.09–4.68; P = .03). Using univariable desirability of outcome ranking analysis, RRT status was associated with a 68% (95% CI, 61%–74%) chance of a worse disposition outcome. Conclusions: Chronic RRT in CRE-infected patients is associated with increased in-hospital mortality and worse disposition outcomes at 28 days.en-UScarbapenem-resistant Enterobacteriaceaemortalityrenal failurerenal replacement therapyJournal Article2017-12-0610.1093/ofid/ofx216