Development of a Nomogram for Carbapenem-Resistant Enterobacteriaceae Acquisition Risk Prediction Among Patients in the Intensive Care Unit of a Secondary Referral Hospital

Abstract Background To establish a risk prediction model for carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infection (BSI) in intestinal carriers. Methods CRE screenings were performed every two weeks in hematology department and intensive care unit (ICU). Patients with positive CRE rectal swab screening were identified using electronic healthcare records from 15 May 2018 to 31 December 2019. All CRE strains were collected and identified. Carriers who developed CRE BSI were compared with those who did not develop CRE infection. The control group 1:1 stratified randomly matched the case group. Univariate logistic analysis, multivariate logistic analysis and stepwise regression analysis were carried out. Results A total of 42 cases were included. Multivariate analysis showed that gastrointestinal injury (OR 86.82, 95%CI 2.58-2916.59, P = 0.013), tigecycline exposure (OR 14.99, 95%CI 1.82-123.74 P = 0.012) and carbapenem resistance score (OR 11.24, 95% CI 1.81–69.70, P = 0.009) were independent risk factors for CRE BSI in intestinal carriers (P < 0.05). They were included in the Logistic regression model to predict BSI. According to receiver operating characteristic (ROC) curve analysis, the cut-off value of the model was 0.72, and the sensitivity, specificity and area under the curve (AUC) were 90.5%, 85.7% and 0.92, respectively. Conclusions The risk prediction model based on gastrointestinal injury, tigecycline exposure and carbapenem resistance score of colonizing strain can effectively predict CRE BSI in patients with CRE colonization. Early CRE screening and detection for inpatients in key departments may early warning and reduce the risk of nosocomial infection of CRE.

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Efficacy of active rapid molecular screening and IPC interventions to reduce carbapenem-resistant Enterobacteriaceae infections in emergency intensive care unit – a prospective, multi-stage study

10.21203/rs.2.16260/v1 ◽

2019 ◽

Author(s):

Wenjuan Wu ◽

Simin Yang ◽

Lihua He ◽

Ke Li ◽

Xiaoyu Yu ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Clinical Laboratory ◽

Health Workers ◽

Experimental Period ◽

Infection Prevention And Control ◽

Molecular Screening ◽

Active Screening ◽

Carbapenem Resistant ◽

Carbapenem Resistant Enterobacteriaceae

Abstract Background: To investigate whether molecular rapid active screening and infection-prevention and control（IPC）interventions can reduce the colonization and infection of carbapenem-resistant Enterobacteriaceae (CRE) in a general emergency intensive care unit (EICU). Methods: The study was designed as a before-and-after quasi-experiment. It was conducted in 3 stages. During stage 1, April 2018, the environment was prepared and the staff in EICU was trained. Stage 2 was the main experimental stage from May 2018 to January 2019. The active screening was tested by semi-nested real-time fluorescent PCR (polymerase chain reaction) detection with rectal swabs from all the patients on admission to EICU and the results would be feedback in 1 hour and other IPC interventions were conducted in strict supervision in this stage. In the last stage (stage 3), February 2019-April 2019, only active screening was strictly executed. Other IPC interventions were carried out by health workers without supervision. In the meantime, the atient information and culture results from clinical laboratory from January 2017-April 2019 were collected. Results: In this 1-year study, a total of 217 patients were enrolled. There were 23.04% of the patients were initially colonized or infected with CRE as tested by active molecular screening. The clinical culture detection rate of CRE colonization/infection was 3.37% during the baseline stage (before this study was carried out), from January 2017-March 2018. The rate decreased significantly to 1.20% (p<0.05) during the main experimental period in which active screening and IPC intervention were executed strictly. However, the rate increased again to 6 .12% in stage 3 in which only active screening were carried out in supervision. Based on the clinical characteristics of the EICU patients, we found there's a higher probability that the patients had invasive devices or skin-barrier damage on admission or had antibiotic use before admission were colonized or infected with CRE (p<0.05). Conclusions : Rapid active screening by molecular detection and other IPC interventions conducted in supervision showed a significant reduction of CRE in nosocomial infection. The key to reduce the spread of CRE in the EICU is that all medical staff and healthcare workers execute IPC interventions strictly.

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A Model-Based Strategy to Control the Spread of Carbapenem-Resistant Enterobacteriaceae: Simulate and Implement

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.168 ◽

2016 ◽

Vol 37 (11) ◽

pp. 1315-1322 ◽

Cited By ~ 12

Author(s):

Mirian de Freitas DalBen ◽

Elisa Teixeira Mendes ◽

Maria Luisa Moura ◽

Dania Abdel Rahman ◽

Driele Peixoto ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hand Hygiene ◽

Tertiary Care ◽

Real Life ◽

Baseline Period ◽

Intervention Period ◽

Support Tool ◽

Carbapenem Resistant ◽

Carbapenem Resistant Enterobacteriaceae

OBJECTIVETo reduce transmission of carbapenem-resistant Enterobacteriaceae (CRE) in an intensive care unit with interventions based on simulations by a developed mathematical model.DESIGNBefore-after trial with a 44-week baseline period and 24-week intervention period.SETTINGMedical intensive care unit of a tertiary care teaching hospital.PARTICIPANTSAll patients admitted to the unit.METHODSWe developed a model of transmission of CRE in an intensive care unit and measured all necessary parameters for the model input. Goals of compliance with hand hygiene and with isolation precautions were established on the basis of the simulations and an intervention was focused on reaching those metrics as goals. Weekly auditing and giving feedback were conducted.RESULTSThe goals for compliance with hand hygiene and contact precautions were reached on the third week of the intervention period. During the baseline period, the calculated R0 was 11; the median prevalence of patients colonized by CRE in the unit was 33%, and 3 times it exceeded 50%. In the intervention period, the median prevalence of colonized CRE patients went to 21%, with a median weekly Rn of 0.42 (range, 0–2.1).CONCLUSIONSThe simulations helped establish and achieve specific goals to control the high prevalence rates of CRE and reduce CRE transmission within the unit. The model was able to predict the observed outcomes. To our knowledge, this is the first study in infection control to measure most variables of a model in real life and to apply the model as a decision support tool for intervention.Infect Control Hosp Epidemiol2016;1–8

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495. Risk Factors of Carbapenem-Resistant Enterobacteriaceae (CRE) Infections Among Intensive Care Unit (ICU) Patients in a Tertiary Hospital in the Philippines

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.564 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S241-S242

Author(s):

Roderick Oreal Torio ◽

Danielle Nicole T Paras ◽

Cybele Lara R Abad

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Hospital Mortality ◽

Length Of Hospital Stay ◽

The Philippines ◽

Common Site ◽

Carbapenem Resistant ◽

Carbapenem Resistant Enterobacteriaceae

Abstract Background The threat of Carbapenem-Resistant Enterobacteriaceae (CRE) is increasing worldwide, and the epidemiology, risk factors, and outcomes of CRE in the Philippines is unknown. Methods We performed a retrospective case–control study of 128 CRE cases and Carbapenem-Susceptible Enterobacteriaceae (CSE) controls matched 1:1 based on site of infection and date of admission among all adult patients in the Intensive Care Unit (ICU) between January 2014 and May 2018 at The Medical City. Predictors of CRE infection among matched cases and controls were determined through multiple conditional logistic regression analysis. In-hospital mortality was analyzed using z-test of two proportions and length of stay among patients with CRE and CSE were compared. Results The mean age in both groups was similar at 65.8 (range 23–92) and 64.3 (range 23–98) years, respectively. There were more males among cases than controls [(76/128, 59%) vs. 62/128 (48%)]. Those with CRE were more likely to have a co-morbid illness and an invasive device. Pneumonia was the most common site of CRE infection (40%) followed by the urinary tract (27%). Enterobacter cloacae (54.68%) was the most common organism, followed by Klebsiella pneumoniae (30.46%). On univariate analysis, the use of piperacillin–tazobactam, third or fourth-generation cephalosporins and carbapenems, mechanical ventilation, and acute kidney injury (AKI) increased the risk of developing CRE infections by an OR of 7.5 (CI 1.88–29.95, P = 0.004), 9.32 (CI 1.48–58.59, P = 0.017), and 10.76 (CI 1.69–68.53, P = 0.012), respectively. Those with CRE had a higher in-hospital mortality than the CSE group [(49/79, 38.3%) vs. (33/95, 25.8%); P = 0.032]. Length of hospital stay among CRE cases was also longer with a mean of 43.9 vs. 28 days compared with controls. Conclusion In our cohort, older patients w/ comorbidities developed CRE with pneumonia being the most common site of infection. Prior use of broad-spectrum antimicrobials, mechanical ventilation and AKI appeared to increase the risk of CRE infection in the ICU. CRE infection also increased patient mortality and length of hospital stay. Interventions that target these risk factors should be undertaken to help prevent CRE infection. Disclosures All authors: No reported disclosures.

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