Risk factors for carbapenem resistant enterobacteriaceae in a teritiary hospital—A case control study

Background Carbapenem-resistant Enterobacteriaceae (CRE) infection has become a major challenge to clinicians. The aim of this study is to identify the risk factors of acquiring CRE to guide more targeted screening for hospital admissions. Methods This is a retrospective case-control study (ratio 1:1) where a patient with CRE infection or colonisation was matched with a control. The control was an individual who tested negative for CRE but was a close contact of a patient testing positive and was admitted at the same time and place. Univariate and multivariate statistical analyses were done. Results The study included 154 patients. The majority of the CRE was Klebsiella species (83%). From univariate analysis, the significant risk factors were having a history of indwelling devices (OR: 2.791; 95% CI: 1.384–5.629), concomitant other MDRO (OR: 2.556; 95% CI: 1.144–5.707) and hospitalisation for more than three weeks (OR: 2.331; 95% CI: 1.163–4.673). Multivariate analysis showed that being unable to ambulate on admission (adjusted OR: 2.345; 95% CI: 1.170–4.699) and antibiotic exposure (adjusted OR: 3.515; 95% CI: 1.377–8.972) were independent predictors. The in-hospital mortality rate of CRE infection was high (64.5%). CRE acquisition resulted in prolonged hospitalisation (median=35 days; P<0.001). Conclusion CRE infection results in high morbidity and mortality. On top of the common risk factors, patients with mobility restriction, prior antibiotic exposures and hospitalisation for more than three weeks should be prioritised in the screening strategy to control the spread of CRE.

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Risk Factors for Recurrence of Carbapenem-Resistant Enterobacteriaceae Carriage: Case-Control Study

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.82 ◽

2015 ◽

Vol 36 (8) ◽

pp. 936-941 ◽

Cited By ~ 29

Author(s):

Yossi Bart ◽

Mical Paul ◽

Orna Eluk ◽

Yuval Geffen ◽

Galit Rabino ◽

...

Keyword(s):

Risk Factors ◽

Case Control Study ◽

Case Control ◽

Positive Sample ◽

Carrier Status ◽

Carbapenem Resistant ◽

Risk Factors For Recurrence ◽

Control Study ◽

Carbapenem Resistant Enterobacteriaceae

BACKGROUNDThe natural history of carbapenem-resistant Enterobacteriaceae (CRE) carriage and the timing and procedures required to safely presume a CRE-free status are unclear.OBJECTIVETo determine risk factors for recurrence of CRE among presumed CRE-free patients.METHODSCase-control study including CRE carriers in whom CRE carriage presumably ended, following at least 2 negative screening samples on separate days. Recurrence of CRE carriage was identified through clinical samples and repeated rectal screening in subsequent admissions to any healthcare facility in Israel. Patients with CRE recurrence (cases) were compared with recurrence-free patients (controls). The duration of follow-up was 1 year for all surviving patients.RESULTSIncluded were 276 prior CRE carriers who were declared CRE-free. Thirty-six persons (13%) experienced recurrence of CRE carriage within a year after presumed eradication. Factors significantly associated with CRE recurrence on multivariable analysis were the time in months between the last positive CRE sample and presumed eradication (odds ratio, 0.94 [95% CI, 0.89–0.99] per month), presence of foreign bodies at the time of presumed eradication (4.6 [1.64–12.85]), and recurrent admissions to healthcare facilities during follow-up (3.15 [1.05–9.47]). The rate of CRE recurrence was 25% (11/44) when the carrier status was presumed to be eradicated 6 months after the last known CRE-positive sample, compared with 7.5% (10/134) if presumed to be eradicated after 1 year.CONCLUSIONSWe suggest that the CRE-carrier status be maintained for at least 1 year following the last positive sample. Screening of all prior CRE carriers regardless of current carriage status is advised.Infect. Control Hosp. Epidemiol. 2015;36(8):936–941

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Prevalence and Risk Factors for Acquisition of Carbapenem-Resistant Enterobacteriaceae in the Setting of Endemicity

Infection Control and Hospital Epidemiology ◽

10.1086/671270 ◽

2013 ◽

Vol 34 (8) ◽

pp. 809-817 ◽

Cited By ~ 101

Author(s):

Mahesh Swaminathan ◽

Saarika Sharma ◽

Stephanie Poliansky Blash ◽

Gopi Patel ◽

David B. Banach ◽

...

Keyword(s):

Risk Factors ◽

Case Control Study ◽

Control Program ◽

Case Control ◽

Case Definition ◽

Colonization Pressure ◽

Carbapenem Resistant ◽

Nested Case Control ◽

Control Study ◽

Carbapenem Resistant Enterobacteriaceae

Objective.To describe the epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) carriage and acquisition among hospitalized patients in an area of CRE endemicity.Design.Cohort study with a nested case-control study.Setting.Two acute care, academic hospitals in New York City.Participants.All patients admitted to 7 study units, including intensive care, medical-surgical, and acute rehabilitation units.Method.Perianal samples were collected from patients at admission and weekly thereafter to detect asymptomatic gastrointestinal carriage of CRE. A nested case-control study was performed to identify factors associated with CRE acquisition. Case patients were those who acquired CRE during a single hospitalization. Control subjects had no microbiologic evidence of CRE and at least 1 negative surveillance sample. Clinical data were abstracted from the medical record.Results.The prevalence of CRE in the study population was 5.4% (306 of 5,676 patients), and 104 patients met the case definition of acquisition during a single hospital stay. Mechanical ventilation (odds ratio [OR], 11.5), pulmonary disease (OR, 5.2), days of antibiotic therapy (OR, 1.04), and CRE colonization pressure (OR, 1.15) were independently associated with CRE acquisition. Pulsed-field gel electrophoresis analysis identified 87% of tested Klebsiella pneumoniae isolates as sharing related patterns (greater than 78% similarity), which suggests clonal transmission within and between the study hospitals.Conclusions.Critical illness and underlying medical conditions, CRE colonization pressure, and antimicrobial exposure are important risk factors for CRE acquisition. Adherence to infection control practices and antimicrobial stewardship appear to be critical components of a CRE control program.

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Outcomes of Carbapenem-Resistant Klebsiella pneumoniae Infection and the Impact of Antimicrobial and Adjunctive Therapies

Infection Control and Hospital Epidemiology ◽

10.1086/592412 ◽

2008 ◽

Vol 29 (12) ◽

pp. 1099-1106 ◽

Cited By ~ 528

Author(s):

Gopi Patel ◽

Shirish Huprikar ◽

Stephanie H. Factor ◽

Stephen G. Jenkins ◽

David P. Calfee

Keyword(s):

Risk Factors ◽

Klebsiella Pneumoniae ◽

Case Control Study ◽

Patient Survival ◽

Case Control ◽

Factors Associated ◽

Carbapenem Resistant ◽

Matched Case ◽

The Impact ◽

Control Study

Background.Carbapenem-resistant Klebsiella pneumoniae is an emerging healthcare-associated pathogen.Objective.To describe the epidemiology of and clinical outcomes associated with carbapenem-resistant K. pneumoniae infection and to identify risk factors associated with mortality among patients with this type of infection.Setting.Mount Sinai Hospital, a 1,171-bed tertiary care teaching hospital in New York City.Design.Two matched case-control studies.Methods.In the first matched case-control study, case patients with carbapenem-resistant K. pneumoniae infection were compared with control patients with carbapenem-susceptible K. pneumoniae infection. In the second case-control study, patients who survived carbapenem-resistant K. pneumoniae infection were compared with those who did not survive, to identify risk factors associated with mortality among patients with carbapenem-resistant K. pneumoniae infection.Results.There were 99 case patients and 99 control patients identified. Carbapenem-resistant K. pneumoniae infection was independently associated with recent organ or stem-cell transplantation (P = .008), receipt of mechanical ventilation (P = .04), longer length of stay before infection (P = .01), and exposure to cephalosporins (P = .02) and carbapenems (P < .001). Case patients were more likely than control patients to die during hospitalization (48% vs 20%; P < .001) and to die from infection (38% vs 12%; P < .001). Removal of the focus of infection (ie, debridement) was independently associated with patient survival (P = .002). The timely administration of antibiotics with in vitro activity against carbapenem-resistant K. pneumoniae was not associated with patient survival.Conclusions.Carbapenem-resistant K. pneumoniae infection is associated with numerous healthcare-related risk factors and with high mortality. The mortality rate associated with carbapenem-resistant K. pneumoniae infection and the limited antimicrobial options for treatment of carbapenem-resistant K. pneumoniae infection highlight the need for improved detection of carbapenem-resistant K. pneumoniae infection, identification of effective preventive measures, and development of novel agents with reliable clinical efficacy against carbapenem-resistant K. pneumoniae.

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