# The clinical and molecular epidemiology of colistin-resistant carbapenem-resistant Enterobacteriaceae (CRE) in long-term acute care hospitals (LTACHs)

> **NIH NIH R01** · UNIVERSITY OF PENNSYLVANIA · 2021 · $768,456

## Abstract

Project Summary
 The emergence and rapid spread of carbapenem-resistant Enterobacteriaceae (CRE) represents a major
public health threat. Infections due to CRE are associated with significant morbidity and mortality, due in part to
limited antibiotic treatment options. The polymyxins, including colistin, are important last-line therapeutic
agents for CRE infections, including as part of combination antibiotic regimens that may reduce mortality.
However, cases of colistin-resistant CRE (colR-CRE) have been recently reported worldwide, and represent a
major therapeutic challenge, as there are no well-studied treatment options available. Post-acute care settings,
and long-term acute care hospitals (LTACHs) in particular, are increasingly important sites of clinical care in
the United States. LTACHs, which are defined by the Centers for Medicare and Medicaid Services (CMS) as
acute care hospitals with an average length of stay of ≥25 days, are characterized by a chronically, critically-ill
population with high rates of antibiotic exposure, indwelling device use, and mechanical ventilation. These
characteristics significantly increase the risk of colonization and infection with colR-CRE in this population.
Rates of colR-CRE are also amplified in LTACHs due to the convergence of complex, high-risk transfers from
multiple acute care hospitals to a single facility. For all of these reasons, LTACHs are likely to be critical in the
emergence and transmission of colR-CRE. However, there is a significant lack of data on the clinical and
molecular epidemiology of colR-CRE specifically in the LTACH setting. This proposal adopts an
interdisciplinary approach, and will link the clinical and molecular epidemiology of colR-CRE to substantially
improve the understanding of this highly drug-resistant pathogen in the LTACH setting. The Specific Aims of
this proposal include the following: Aim 1: To identify risk factors for colonization or infection with colR-CRE in
LTACH patients; Aim 2: To evaluate the impact of colR-CRE colonization or infection on mortality in the
LTACH setting; Aim 3: To use whole-genome sequencing to prospectively evaluate colR-CRE isolates from a
regional network of LTACHs with a high baseline prevalence of CRE. The completion of the proposed research
aims will provide critical insights into the clinical and molecular epidemiology of colistin resistance in CRE in a
healthcare setting of increasing importance. Elucidation of the epidemiology of colR-CRE will significantly
inform the development of effective infection prevention and antibiotic stewardship strategies to limit the
emergence and transmission of these organisms. In addition, a broader understanding of the epidemiology of
colR-CRE in LTACHs is critical for reducing rates of colR-CRE across highly connected short-term and long-
term acute care settings, including understanding the role of LTACHs as sentinel facilities for the emergence of
colR-CRE.

## Key facts

- **NIH application ID:** 9934119
- **Project number:** 5R01AI139240-03
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** EBBING LAUTENBACH
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $768,456
- **Award type:** 5
- **Project period:** 2018-06-01 → 2024-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9934119

## Citation

> US National Institutes of Health, RePORTER application 9934119, The clinical and molecular epidemiology of colistin-resistant carbapenem-resistant Enterobacteriaceae (CRE) in long-term acute care hospitals (LTACHs) (5R01AI139240-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9934119. Licensed CC0.

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