Carbapenem-Resistant Enterobacteriaceae Screening: A Core Infection Control Measure for Critical Care Unit in India?

Ramanathan, Yamunadevi; Ramasubramanian, V; Nambi, P Senthur; Ramabathiran, Madhumitha; Venkataraman, Ramesh; Thirunarayan, M A; Samundeeswari, P.; Ramakrishnan, Nagarajan

doi:10.4103/ijmm.ijmm_18_437

Cited by 13 publications

(7 citation statements)

References 10 publications

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“…There were signi cant differences between active surveillance-positive and-negative groups for length of hospital stay before surveillance, length of mechanical ventilation before surveillance, carbapenem antibiotic use 90 days prior to surveillance, corticosteroid use 90 days before surveillance, and surgery 90 days before surveillance; these ndings are consistent with those of prior studies [22,24,26]. Moreover, enteral nutrition before surveillance was not associated with the presence of carbapenem resistance genes.…”

Section: Discussionsupporting

confidence: 88%

“…Studies have shown that the CRO carrier rate in hospitalized patients is low, suggesting that because of the relatively low prevalence of CRO, it is not cost-effective to screen all ICU admissions [4,24,25]. Highrisk individualized active surveillance in high-risk settings, such as the ICU, helps to detect asymptomatic CRO carriers who can serve as reservoirs for transmission during hospitalization.…”

Section: Discussionmentioning

confidence: 99%

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Individualized active surveillance for carbapenem-resistant microorganisms using Xpert Carba-R in intensive care units: A single center, before-after study

Zhou

Mi²,

Rao

et al. 2023

Preprint

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Background Carbapenem antibiotics are widely used in intensive care units (ICU), and the prevalence of carbapenem-resistant microorganisms (CRO) has increased, forming a major threat to inpatients that urgently requires improved surveillance. This study aimed to assess the role of individualized active surveillance of carbapenem resistance genes on CRO risk. Methods A total of 3,765 patients were admitted to the ICU of Zhongnan Hospital of Wuhan University between 2020 and 2022 (March 2020 to February 2021 in the first period and March 2021 to February 2022 in the second period). The presence of carbapenem resistance genes were monitored using Xpert Carba-R, and CRO incidence was assigned as the investigated outcome. Results Of 3,765 patients, 390 manifested the presence of CRO, representing a prevalence of 10.36%. Active surveillance was associated with a lower CRO risk (odds ratio [OR]: 0.77; 95% confidence interval [CI]: 0.62–0.95; P = 0.013), especially for carbapenem-resistant Acinetobacter + carbapenem-resistant Pseudomonas aeruginosa (OR: 0.79; 95%CI: 0.62–0.99; P = 0.043), carbapenem-resistant Klebsiella pneumoniae (OR: 0.56; 95%CI: 0.40–0.79; P = 0.001), and carbapenem-resistant Enterobacteriaceae (OR: 0.65; 95%CI: 0.47–0.90; P = 0.008). However, active surveillance was not associated with risk of carbapenem-resistant Acinetobacter (P = 0.140), carbapenem-resistant Pseudomonas aeruginosa (P = 0.161), carbapenem-resistant Enterobacteriaceae (except CRKP) (P = 0.259), or ICU stay (P = 0.743). Moreover, there were significant differences between positive and negative active surveillance in high-risk patients with a CRO-positive culture (P < 0.001) or microorganism-positive culture (P < 0.001), time between ICU admission and CRO positivity (P < 0.001), length of hospital stay before surveillance (P = 0.002), carbapenem antibiotic use in the 90 days before surveillance (P = 0.001), corticosteroid use in the 90 days prior to surveillance (P = 0.028), and surgery in the 90 days before surveillance (P = 0.003). Conclusions Individualized active surveillance using Xpert Carba-R may be associated with a reduction in the overall CRO incidence in the ICU, especially for carbapenem-resistant Acinetobacter + carbapenem-resistant Pseudomonas aeruginosa, carbapenem-resistant Klebsiella pneumoniae, and carbapenem-resistant Enterobacteriaceae. Further prospective studies should be performed to verify these conclusions and guide further management of patients in the ICU.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Individualized active surveillance for carbapenem-resistant microorganisms using Xpert Carba-R in intensive care units: A single center, before-after study

Zhou

Mi²,

Rao

et al. 2023

Preprint

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“…However, these treatments are not optimized and lead to increased resistance rates, including resistance to third generation cephalosporins (10-97%) [13,17]. This highlights the relevance of multidrug-resistance (MDR) bacteria in healthcare-associated infections (HAIs) [8,13,[19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

The importance of active surveillance of carbapenem-resistant Enterobacterales (CRE) in colonization rates in critically ill patients

Gomides¹,

Fontes²,

Silveira³

et al. 2022

PLoS ONE

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Objective This study aimed to demonstrate the importance of active carbapenem-resistant Enterobacterales (CRE) surveillance and evaluate the prevalence of invasive infections, risk factors, and mortality risk in CRE-colonized patients. Methods Retrospective cohort study analyzing 1,920 patients identified using an active CRE surveillance protocol, admitted to an adult intensive care unit in southeastern Brazil from January 2014 to December 2018. Results There were 297 (15.47%) CRE colonized patients, with one colonized for every six control patients. CRE-colonized patients demonstrated an increased chance of infection (odds ratio [OR] 7.967, p < 0.001). Overall, 20.54% of the colonized patients presented invasive infection (81.96% due to Klebsiella pneumoniae). The colonization and infection ratio demonstrated the important role of the active CRE surveillance protocol. There were identified multiple risk factors for CRE colonization, including long-term mechanical ventilation (OR 1.624, p = 0.019) and previous exposure to aminopenicillins (OR 5.204, p < 0.001), carbapenems (OR 3.703, p = 0.017), cephalosporins (OR 12.036, p < 0.001), and fluoroquinolones (OR 5.238, p = 0.012). The mortality risk was significantly higher among colonized (OR 2.356, p < 0.001) and colonized-infected (OR 2.000, p = 0.009) patients and in those with Enterobacter cloacae colonization (OR 5.173, p < 0,001) and previous aminopenicillins exposure (OR 3.452, p = 0.007). Conclusions Early detection of CRE colonization through screening testing proved to be an important tool to control CRE spread. However, observation over the years has shown no effective control of colonization and infection. The prevalence rates of CRE colonization and colonization-infection were high, as were the mortality rates. In conclusion, an active CRE surveillance protocol is essential, but its impact depends on the effective implementation of preventive measures and feedback between team members.

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“…Studies have shown that the CRO carrier rate in hospitalized patients is low, suggesting that because of the relatively low prevalence of CRO, it is not cost-effective to screen all ICU admissions 4 , 24 , 25 . High-risk individualized active surveillance in high-risk settings, such as the ICU, helps to detect asymptomatic CRO carriers who can serve as reservoirs for transmission during hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Individualized active surveillance for carbapenem-resistant microorganisms using Xpert Carba-R in intensive care units

Zhou

Rao

et al. 2023

Sci Rep

View full text Add to dashboard Cite

Carbapenem antibiotics are widely used in ICU, and the prevalence of carbapenem-resistant microorganisms (CRO) has increased. This study aimed to assess the role of individualized active surveillance using Xpert Carba-R of carbapenem resistance genes on CRO risk. A total of 3,765 patients were admitted to the ICU of Zhongnan Hospital of Wuhan University between 2020 and 2022. The presence of carbapenem resistance genes were monitored using Xpert Carba-R, and CRO incidence was assigned as the investigated outcome. Of 3,765 patients, 390 manifested the presence of CRO, representing a prevalence of 10.36%. Active surveillance using Xpert Carba-R was associated with a lower CRO risk (odds ratio [OR]: 0.77; 95% confidence interval [CI] 0.62–0.95; P = 0.013), especially for carbapenem-resistant Acinetobacter + carbapenem-resistant Pseudomonas aeruginosa (OR: 0.79; 95% CI 0.62–0.99; P = 0.043), carbapenem-resistant Klebsiella pneumoniae (OR: 0.56; 95% CI 0.40–0.79; P = 0.001), and carbapenem-resistant Enterobacteriaceae (OR: 0.65; 95% CI 0.47–0.90; P = 0.008). Individualized active surveillance using Xpert Carba-R may be associated with a reduction in the overall CRO incidence in ICU. Further prospective studies should be performed to verify these conclusions and guide further management of patients in ICU.

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Carbapenem-Resistant Enterobacteriaceae Screening: A Core Infection Control Measure for Critical Care Unit in India?

Cited by 13 publications

References 10 publications

Individualized active surveillance for carbapenem-resistant microorganisms using Xpert Carba-R in intensive care units: A single center, before-after study

Individualized active surveillance for carbapenem-resistant microorganisms using Xpert Carba-R in intensive care units: A single center, before-after study

The importance of active surveillance of carbapenem-resistant Enterobacterales (CRE) in colonization rates in critically ill patients

Individualized active surveillance for carbapenem-resistant microorganisms using Xpert Carba-R in intensive care units

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