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Risk Factors for Colonization due to Carbapenem-Resistant Enterobacteriaceae among Patients: Exposed to Long-Term Acute Care and Acute Care Facilities

Published online by Cambridge University Press:  10 May 2016

Ashish Bhargava ,
Kayoko Hayakawa ,
Ethan Silverman ,
Samran Haider ,
Krishna Chaitanya Alluri ,
Satya Datla ,
Sreelatha Diviti ,
Vamsi Kuchipudi ,
Kalyan Srinivas Muppavarapu  and
Paul R. Lephart
...Show all authors
Ashish Bhargava*
Affiliation:
Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan
Kayoko Hayakawa
Affiliation:
Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan
Ethan Silverman
Affiliation:
Wayne State School of Medicine, Detroit, Michigan
Samran Haider
Affiliation:
Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan
Krishna Chaitanya Alluri
Affiliation:
Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan
Satya Datla
Affiliation:
Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan
Sreelatha Diviti
Affiliation:
Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan
Vamsi Kuchipudi
Affiliation:
Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan
Kalyan Srinivas Muppavarapu
Affiliation:
Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan
Paul R. Lephart
Affiliation:
Detroit Medical Center, Detroit, Michigan
Dror Marchaim
Affiliation:
Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan
Keith S. Kaye
Affiliation:
Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan
*
5 Hudson Harper, 540 East Canfield, Detroit Medical Center, Room 5911, Detroit, MI 48201 (drashishbhargava@gmail.com)
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Abstract

Background.

This study aimed to identify risk factors associated with carbapenem-resistant Enterobacteriaceae (CRE) colonization among patients screened with rectal cultures upon admission to a hospital or long-term acute care (LTAC) center and to compare risk factors among patients who were screen positive for CRE at the time of hospital admission with those screen positive prior to LTAC admission.

Methods.

A retrospective nested matched case-control study was conducted from June 2009 to December 2011. Patients with recent LTAC exposure were screened for CRE carriage at the time of hospital admission, and patients admitted to a regional LTAC facility were screened prior to LTAC admission. Cases were patients with a positive CRE screening culture, and controls (matched in a 3:1 ratio to cases) were patients with negative screening cultures.

Results.

Nine hundred five cultures were performed on 679 patients. Forty-eight (7.1%) cases were matched to 144 controls. One hundred fifty-eight patients were screened upon hospital admission and 521 prior to LTAC admission. Independent predictors for CRE colonization included Charlson's score greater than 3 (odds ratio [OR], 4.85 [95% confidence interval (CI), 1.64–14.41]), immunosuppression (OR, 3.92 [95% CI, 1.08–1.28]), presence of indwelling devices (OR, 5.21 [95% CI, 1.09–2.96]), and prior antimicrobial exposures (OR, 3.89 [95% CI, 0.71–21.47]). Risk factors among patients screened upon hospital admission were similar to the entire cohort. Among patients screened prior to LTAC admission, the characteristics of the CRE-colonized and noncolonized patients were similar.

Conclusions.

These results can be used to identify patients at increased risk for CRE colonization and to help target active surveillance programs in healthcare settings.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 4: Special Topic Issue: Carbapenem-Resistant Enterobacteriaceae and Multidrug-Resistant Organisms , April 2014 , pp. 398 - 405
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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References

1. Patel, G, Huprikar, S, Factor, SH, Jenkins, SG, Calfee, DP. Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol 2008;29(12):1099–1106.Google Scholar
2. Hidron, AI, Edwards, JR, Patel, J, et al. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infect Control Hosp Epidemiol 2008;29(11):996–1011.Google Scholar
3. 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(3):1028–1033.Google Scholar
4. Yigit, H, Queenan, AM, Anderson, GJ, et al. Novel carbapenem-hydrolyzing beta-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae. Antimicrob Agents Chemother 2001;45(4):1151–1161.CrossRefGoogle ScholarPubMed
5. Cuzon, G, Naas, T, Truong, H, et al. Worldwide diversity of Klebsiella pneumoniae that produce beta-lactamase blaKPC-2 gene. Emerg Infect Dis 2010;16(9):1349–1356.Google Scholar
6. Kitchel, B, Rasheed, JK, Patel, JB, et al. Molecular epidemiology of KPC-producing Klebsiella pneumoniae isolates in the United States: clonal expansion of multilocus sequence type 258. Antimicrob Agents Chemother 2009;53(8):3365–3370.Google Scholar
7. Bratu, S, Landman, D, Haag, R, et al. Rapid spread of carbapenem-resistant Klebsiella pneumoniae in New York City: a new threat to our antibiotic armamentarium. Arch Intern Med 2005;165(12):1430–1435.CrossRefGoogle ScholarPubMed
8. Carmeli, Y, Akova, M, Cornaglia, G, et al. Controlling the spread of carbapenemase-producing gram-negatives: therapeutic approach and infection control. Clin Microbiol Infect 2010;16(2):102–111.Google Scholar
9. Robicsek, A, Beaumont, JL, Paule, SM, et al. Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med 2008;148(6):409–418.Google Scholar
10. Ostrowsky, BE, Trick, WE, Sohn, AH, et al. Control of vancomycin-resistant enterococcus in health care facilities in a region. N Engl J Med 2001;344(19):1427–1433.Google Scholar
11. Schechner, V, Straus-Robinson, K, Schwartz, D, et al. Evaluation of PCR-based testing for surveillance of KPC-producing carbapenem-resistant members of the Enterobacteriaceae family. J Clin Microbiol 2009;47(10):3261–3265.Google Scholar
12. Munoz-Price, LS, Hayden, MK, Lolans, K, et al. Successful control of an outbreak of Klebsiella pneumoniae carbapenemase–producing K. pneumoniae at a long-term acute care hospital. Infect Control Hosp Epidemiol 2010;31(4):341–347.CrossRefGoogle Scholar
13. Schwaber, MJ, Lev, B, Israeli, A, et al. Containment of a country-wide outbreak of carbapenem-resistant Klebsiella pneumoniae in Israeli hospitals via a nationally implemented intervention. Clin Infect Dis 2011;52(7):848–855.Google Scholar
14. Schechner, V, Kotlovsky, T, Tarabeia, J, et al. Predictors of rectal carriage of carbapenem-resistant Enterobacteriaceae (CRE) among patients with known CRE carriage at their next hospital encounter. Infect Control Hosp Epidemiol 2011;32(5):497–503.Google Scholar
15. Gasink, LB, Edelstein, PH, Lautenbach, E, Synnestvedt, M, Fishman, NO. Risk factors and clinical impact of Klebsiella pneumoniae carbapenemase–producing K. pneumoniae . Infect Control Hosp Epidemiol 2009;30(12):1180–1185.CrossRefGoogle ScholarPubMed
16. Zarkotou, O, Pournaras, S, Voulgari, E, et al. Risk factors and outcomes associated with acquisition of colistin-resistant KPC-producing Klebsiella pneumoniae, a matched case-control study. J Clin Microbiol 2010;48(6):2271–2274.Google Scholar
17. Hussein, K, Sprecher, H, Mashiach, T, Oren, I, Kassis, I, Finkelstein, R. Carbapenem resistance among Klebsiella pneumoniae isolates: risk factors, molecular characteristics, and susceptibility patterns. Infect Control Hosp Epidemiol 2009;30(7):666–671.Google Scholar
18. Mouloudi, E, Protonotariou, E, Zagorianou, A, et al. Bloodstream infections caused by metallo-β-lactamase/Klebsiella pneumoniae carbapenemase–producing K. pneumoniae among intensive care unit patients in Greece: risk factors for infection and impact of type of resistance on outcomes. Infect Control Hosp Epidemiol 2010;31(12):1250–1256.CrossRefGoogle ScholarPubMed
19. Marchaim, D, Chopra, T, Perez, F, et al. Outcomes and genetic relatedness of carbapenem-resistant Enterobacteriaceae at Detroit Medical Center. Infect Control Hosp Epidemiol 2011;32(9):861–871.CrossRefGoogle ScholarPubMed
20. Marchaim, D, Chopra, T, Pogue, JM, et al. Outbreak of colistin-resistant, carbapenem-resistant Klebsiella pneumoniae in metropolitan Detroit, Michigan. Antimicrob Agents Chemother 2011;55(2):593–599.CrossRefGoogle ScholarPubMed
21. Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40(5):373–383.CrossRefGoogle ScholarPubMed
22. Centers for Disease Control and Prevention (CDC). Laboratory protocol for detection of carbapenem-resistant or carbapenemase-producing, Klebsiella spp. and E. coli from rectal swabs. Atlanta: CDC, 2013. http://www.cdc.gov/hai/pdfs/labsettings/klebsiella_or_ecoli.pdf.Google Scholar
23. Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing: 19th informational supplement. Wayne, PA: CLSI, 2011. CLSI document M100-S21.Google Scholar
24. Swaminathan, M, Sharma, S, Poliansky Blash, S, et al. Prevalence and risk factors for acquisition of carbapenem-resistant Enterobacteriaceae in the setting of endemicity. Infect Control Hosp Epidemiol 2013;34(8):809–817.Google Scholar
25. Chitnis, AS, Caruthers, PS, Rao, AK, et al. Outbreak of carbapenem-resistant Enterobacteriaceae at a long-term acute care hospital: sustained reductions in transmission through active surveillance and targeted interventions. Infect Control Hosp Epidemiol 2012;33(10):984–992.Google Scholar
26. Rosenthal, VD, Maki, DG, Salomao, R, et al. Device-associated nosocomial infections in 55 intensive care units of 8 developing countries. Ann Intern Med 2006;145(8):582–591.Google Scholar
27. Moreno, CA, Rosenthal, VD, Olarte, N, et al. Device-associated infection rate and mortality in intensive care units of 9 Colombian hospitals: findings of the International Nosocomial Infection Control Consortium. Infect Control Hosp Epidemiol 2006;27(4):349–356.Google Scholar
28. Wang, L, Lansing, B, Symons, K, et al. Infection rate and colonization with antibiotic-resistant organisms in skilled nursing facility residents with indwelling devices. Eur J Clin Microbiol Infect Dis 2012;31(8):1797–804.Google Scholar
29. Pawar, M, Mehta, Y, Purohit, A, Trehan, N, Rosenthal, VD. Resistance in gram-negative bacilli in a cardiac intensive care unit in India: risk factors and outcome. Ann Card Anaesth 2008;11(1):20–26.Google Scholar
30. Marchaim, D, Chopra, T, Bhargava, A, Bogan, C, Dhar, S, Hayakawa, K, et al. Recent exposure to antimicrobials and carbapenem-resistant Enterobacteriaceae: the role of antimicrobial stewardship. Infect Control Hosp Epidemiol 2012;33(8):817–830.Google Scholar
31. Kwak, YG, Choi, SH, Choo, EJ, Chung, JW, Jeong, JY, Kim, NJ, et al. Risk factors for the acquisition of carbapenem-resistant Klebsiella pneumoniae among hospitalized patients. Microb Drug Resist 2005;11(2):165–169.CrossRefGoogle ScholarPubMed
32. Falagas, ME, Rafailidis, PI, Kofteridis, D, et al. Risk factors of carbapenem-resistant Klebsiella pneumoniae infections: a matched case control study. J Antimicrob Chemother 2007;60(5):1124–1130.CrossRefGoogle ScholarPubMed
33. 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(5):421–425.Google Scholar
34. Jeon, MH, Choi, SH, Kwak, YG, et al. Risk factors for the acquisition of carbapenem-resistant Escherichia coli among hospitalized patients. Diagn Microbiol Infect Dis 2008;62(4):402–406.CrossRefGoogle ScholarPubMed
35. Perez, F, Pultz, MJ, Endimiani, A, Bonomo, RA, Donskey, CJ. Effect of antibiotic treatment on establishment and elimination of intestinal colonization by KPC-producing Klebsiella pneumonia in mice. Antimicrob Agents Chemother 2011;55(6):2585–2589.Google Scholar
36. Ben-David, D, Maor, Y, Keller, N, et al. Potential role of active surveillance in the control of a hospital-wide outbreak of carbapenem-resistant Klebsiella pneumoniae infection. Infect Control Hosp Epidemiol 2010;31(6):620–626.Google Scholar