Construction of a risk prediction model for subsequent bloodstream infection in intestinal carriers of carbapenem-resistant Enterobacteriaceae: a retrospective study in hematology department and intensive care unit

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.

Risk factors for carbapenem‐resistant Enterobacterales infection among hospitalized patients with previous colonization

“…A previous study showed that CRE isolates in Miami‐Dade County were predominantly K. pneumoniae 20 . Consistent with previous studies, the main carbapenem‐resistant bacteria in bloodstream infections among rectal carriers was K. pneumoniae (73.8% of the cases) 21 . A recent study on 702 patients suggested that carriers of carbapenemase‐producing K. pneumoniae may have an increased likelihood of prolonged carriage 22 …”

“…20 Consistent with previous studies, the main carbapenem-resistant bacteria in bloodstream infections among rectal carriers was K. pneumoniae (73.8% of the cases). 21 A recent study on 702 patients suggested that carriers of carbapenemaseproducing K. pneumoniae may have an increased likelihood of prolonged carriage. 22 A previous Chinese study found that 37.1% of intestinal CRKP carriers developed clinical CRKP infections; additionally, ICU admission was an independent risk factor for subsequent clinical infections among intestinal CRKP carriers.…”

Bacteriological Profile and Antimicrobial Susceptibility Patterns of Gram-Negative Bloodstream Infection and Risk Factors Associated with Mortality and Drug Resistance: A Retrospective Study from Shanxi, China

“…Although there were few studies on this mechanism, one study reported that tigecycline exposure increased the risk of carbapenem resistance Enterobacteriales BSI might be due to intestinal flora disorder. 54 The specific mechanisms need more research. To our knowledge, tigecycline has a large volume of distribution and high concentration in gallbladder, colon and pulmonary tissue.…”