Epidemiology of the Emergence of Carbapenemase-Producing Enterobacteriaceae in South-Central Ontario, Canada
Bibliographic record
Abstract
Background. Carbapenemase-producing Enterobacteriaceae (CPE) are an increasing threat. Here, we describe the CPE epidemiology in Southern Ontario, Canada. Methods. We analyzed Toronto Invasive Bacterial Diseases Network (TIBDN) population-based surveillance data from first isolates in October 2007 to April 2016. Patients diagnosed after January 2013 were asked to participate in a prospective cohort, where they were asked for healthcare visits/travel abroad. Results. We identified 270 CPE patients with a median age of 70 years (Table). The incidence increased from 0 in 2006 to 1.1/100 000 in 2015. The most frequent species and enzyme were Klebsiella pneumoniae and New Delhi metallo-β-lactamase (NDM). Incidence and distribution varied significantly in adjacent urban areas (Figures 1 and 2). Of 103 (38%) patients with a CPE infection, 74 (72%) had urinary tract infection, and 24 (23%) blood stream infection. Overall in-hospital mortality was 16%. Among 77 prospectively enrolled patients, healthcare in the Indian subcontinent 1 year prior to CPE identification was reported by 26 of 45 (58%) patients with NDM compared to 4 of 32 (13%) with non-NDM CPE (P < 0.001). Among patients with non-NDM CPE, 18 of 32 (56%) reported no healthcare abroad or travel to the Indian subcontinent (Figure 3). Conclusion. Carbapenemase-producing Enterobacteriaceae are increasing in Southern Ontario. Incidence and risk factors differ clearly by geography. A majority of patients with non-NDM CPE appear to have acquired their CPE in a Canadian hospital. Characteristics of Patients Colonized/Infected With Carbapenemase-Producing Enterobacteriaceae. Numbers Are n (%) If Not Stated Otherwise Disclosures. J. Powis, GSK: Investigator, Research support; S. Poutanen, Merck: Board Member, Honoraria and Speaker honorarium. Paladin Labs: Board Member, Honoraria. Accelerate Diagnostics: Board Member, Honoraria
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.003 | 0.005 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.002 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".