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Risk factors and outcomes of patients colonized with carbapenemase-producing and non–carbapenemase-producing carbapenem-resistant Enterobacteriaceae

Published online by Cambridge University Press:  23 June 2020

Amal Kassem ,
Aman Raed ,
Tal Michael ,
Orli Sagi ,
Orly Shimoni ,
Abraham Borer  and
Lisa Saidel-Odes Open the ORCID record for Lisa Saidel-Odes [Opens in a new window]
Amal Kassem
Affiliation:
The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Aman Raed
Affiliation:
The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Tal Michael
Affiliation:
Department of Public Health, the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Orli Sagi
Affiliation:
Clinical Microbiology Laboratory, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Orly Shimoni
Affiliation:
Hospital Pharmacy, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Abraham Borer
Affiliation:
Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Lisa Saidel-Odes*
Affiliation:
Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
*
Author for correspondence: Lisa Saidel-Odes, E-mail: lisasod@clalit.org.il
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Abstract

Objective:

To compare risk factors and outcome of patients colonized with carbapenemase-producing (CP) carbapenem-resistant Enterobactereaceae (CRE) and non–CP-CRE.

Design:

A comparative historical study.

Setting:

A 1,000-bed tertiary-care university hospital.

Patients:

Adults with CP-CRE positive rectal swab cultures, non–CP-CRE positive rectal swab cultures, and negative rectal swab cultures (non-CRE).

Methods:

CP-CRE and non–CP-CRE colonized adult patients versus patients not colonized with CRE hospitalized during 24 months were included. We identified patients retrospectively through the microbiology laboratory, and we reviewed their files for demographics, underlying diseases, Charlson Index, treatment, and outcome.

Results:

This study included 447 patients for whom a rectal swab for CRE was obtained: 147 positive for CP-CRE, 147 positive for non–CP-CRE, and 147 negative for both. Patients with CP-CRE and non–CP-CRE versus no CRE more frequently resided in nursing homes (P<0.001), received antibiotics 3 months prior to admission (P < .001), and received glucocorticosteroids 3 months prior to admission (P = .047 and P < .001, respectively). Risk factors unique for non–CP-CRE versus CP-CRE colonization included mechanical ventilation and patient movement between hospital departments. Non–CP-CRE was a predictor for mechanical ventilation 2.5 that of CP-CRE colonization. In-hospital mortality was highest among non–CP-CRE–colonized patients. On COX multivariate regression for mortality prediction age, Charlson index and steroid treatment 3 months before admission influenced mortality (P = .027, P = .023, and P = .013, respectively).

Conclusions:

Overlapping and unique risk factors are associated with CP-CRE and non–CP-CRE colonization. Non–CP-CRE colonized patients had a higher in-hospital mortality rate.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 10 , October 2020 , pp. 1154 - 1161
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

a

Authors of equal contribution.

References

Tangden, T, Giske, CG.Global dissemination of extensively drug-resistant carbapenemase-producing Enterobacteriaceae: clinical perspective on detection, treatment and infection control. J Intern Med 2015;277:501–512.CrossRefGoogle ScholarPubMed
Borer, A, Saidel-Odes, L, Riesenberg, K, et al.Attributable mortality of carbapenem resistant Klebsiella pneumoniae bacteremia. Infect Control Hosp Epidemiol 2009;30:972–976.CrossRefGoogle ScholarPubMed
Albiger, B, Glasner, C, Struelens, MJ, et al.Carbapenemase-producing Enterobacteriaceae in Europe: assessment by national experts from 38 countries, May 2015. Euro Surveill 2015;20(45). doi: 10.2807/1560-7917.CrossRefGoogle ScholarPubMed
FAQs about choosing and implementing a CRE definition. Centers for Disease Control and Prevention website. http://www/cdc.gov/hai/organisms/cre/definition.html. Accessed June 27, 2016.Google Scholar
Tamma, PD, Huang, Y, Opene, BNA, Simner, PJ.Determining the optimal carbapenem MIC that distinguishes carbapenemase-producing and non-carbapenemase-producing carbapenem-resistant Enterobacteriaceae. Antimicrob Agents Chemother 2016;60:6425–6429.10.1128/AAC.00838-16CrossRefGoogle ScholarPubMed
Doi, Y, Paterson, DL.Carbapenemase-producing Enterobacteriaceae. Semin Respir Crit Care Med 2015;36:74–84.Google ScholarPubMed
Chiotos, K, Han, JH, Tamma, PD.Carbapenem-resistant Enterobacteriaceae in Children. Curr Infect Dis Rep 2016;18:2.10.1007/s11908-015-0510-9CrossRefGoogle ScholarPubMed
Vink, JP, Otter, JA, Edgeworth, JD.Carbapenemase-producing Enterobacteriaceae—once positive always positive? Gastrointestinal Infect 2020;36:9–16.Google ScholarPubMed
Kang, JS, Yi, J, Ko, MK, Lee, SO, Lee, JE, Kim, KH.Prevalence and risk factors of carbapenem-resistant Enterobacteriaceae acquisition in an emergency intensive care unit in a tertiary hospital in Korea: a case-control study. J Korean Med Sci 2019;34:e140.CrossRefGoogle Scholar
Marimuthu, K, Ng, OT, Cherng, BPZ, et al.Antecedent carbapenem exposure as a risk factor for non-carbapenemase-producing carbapenem-resistant enterobacteriaceae and carbapenemase-producing enterobacteriaceae. Anitimicrob Agents Chemother 2019;63:e00845–19.Google ScholarPubMed
Ling, ML, Tee, YM, Tan, SG, et al.Risk factors for acquisition of carbapenem resistant Enterobacteriaceae in an acute tertiary care hospital in Singapore. Antimicrob Resist Infect Control 2015;4:26.CrossRefGoogle Scholar
Saidel-Odes, L, Borer, A.Limiting and controlling carbapenem-resistant Klebsiella pneumoniae. Infect Drug Resist 2014;7:9–14.Google Scholar
Schwaber, MJ, Carmeli, Y.An ongoing national intervention to contain the spread of carbapenem-resistant Enterobacteriaceae. Clin Infect Dis 2014;58:697–703.10.1093/cid/cit795CrossRefGoogle ScholarPubMed
Jamal, AJ, Gracia-Jeldes, F, Baqi, M, et al.Infection prevention and control practices related to carbapenemase-producing Enterobacteriaceae(CPE) in acute-care hospitals in Ontario, Canada. Infect Control Hosp Epidemiol 2019;40:1006–1012.10.1017/ice.2019.173CrossRefGoogle ScholarPubMed
Tamma, PD, Goodman, K, Harris, AD, Tekle, T, Roberts, A, Taiwo, A, Simner, PJ.Comparing the outcomes of patients with carbapenemase-producing and non-carbapenemase-producing carbapenem-resistant Enterobacteriaceae Bacteremia. Clin Infect Dis 2017;64:257–264.CrossRefGoogle ScholarPubMed
Dautzenberg, MJ, Wekesa, AN, Gniadkowski, M, et al.The association between colonization with carbapenemase-producing Enterobacteriaceae and overall ICU mortality: an observational cohort study. Crit Care Med 2015;43:1170–1177.CrossRefGoogle ScholarPubMed
Mathers, AJ, Vegesana, K, German-Mesner, I, et al.Risk factors for Klebsiella pneumonia carbapenemase (KPC) gene acquisition and clinical outcomes across multiple bacterial species. J Hosp Infect 2020 Jan 10. pii: S0195-6701(20)30007-4.CrossRefGoogle Scholar
Schwaber, MJ, Klarfeld-Lidji, S, Navon-Venezia, S, Schwartz, D, Leavitt, A, Carmeli, Y.Predictors of carbapenem-resistant Klebsiella pneumoniae acquisition among hospitalized adults and effect of acquisition on mortality. Antimicrob Agents Chemother 2008;52:1028–1033.10.1128/AAC.01020-07CrossRefGoogle ScholarPubMed
Borer, A, Saidel-Odes, L, Eskira, S, et al.Risk factors for developing clinical infection with carbapenem-resistant Klebsiella pneumoniae in hospital patients initially only colonized with carbapenem-resistant K pneumoniae. Am J Infect Control 2012;40:421–425.CrossRefGoogle ScholarPubMed
Kwak, YG, Choi, SH, Choo, EJ, et al.Risk factors for the acquisition of carbapenem-resistant Klebsiella pneumoniae among hospitalized patients. Microb Drug Resist 2005;11:165–169.CrossRefGoogle ScholarPubMed
Nicolas-Chanoine, MH, Vigan, M, Laouénan, C, Robert, J.Risk factors for carbapenem-resistant Enterobacteriaceae infections: a French case-control-control study. Eur J Clin Microbiol Infect Dis 2019;38:383–393.CrossRefGoogle ScholarPubMed
Asai, N, Sakanashi, D, Suematsu, H, et al.The epidemiology and risk factor of carbapenem-resistant Enterobacteriaceae colonization and infections: case control study in a single institute in Japan. J Infect Chemother 2018;24:505–509.CrossRefGoogle Scholar
Eser, F, Yılmaz, GR, Güner, R, et al.Risk factors for rectal colonization of carbapenem-resistant Enterobacteriaceae in a tertiary-care hospital: a case-control study from Turkey. Turk J Med Sci 2019;49:341–346.CrossRefGoogle Scholar
Predic, M, Delano, JP, Tremblay, E, Iovine, N, Brown, S, Prins, C.Evaluation of patient risk factors for infection with carbapenem-resistant Enterobacteriaceae. Am J Infect Control 2020;S0196-6553(19)31012-0.10.1016/j.ajic.2019.11.025CrossRefGoogle ScholarPubMed
Stuck, AE, Minder, CE, Frey, FJ.Risk of infectious complications in patients taking glucocorticosteroids. Rev Infect Dis 1989;11:954–963.CrossRefGoogle ScholarPubMed
Abad, C, Fearday, A, Safdar, N.Adverse effects of isolation in hospitalised patients: a systemic review. J Hosp Infect 2010;76:97–102.10.1016/j.jhin.2010.04.027CrossRefGoogle Scholar