Fecal Carriage of Carbapenem-Resistant Enterobacteriaceae and Risk Factor Analysis in Hospitalised Patients: A Single Centre Study from India

Mohan, Balvinder; Prasad, A.; Kaur, Harsimran; Hallur, Vinaykumar; Gautam, Neha; Taneja, Neelam

doi:10.4103/ijmm.ijmm_17_144

Cited by 32 publications

(30 citation statements)

References 31 publications

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“…In this study, pneumonia/chronic pulmonary disease, previous use of fluoroquinolone, and nasogastric tube were documented as risk factors. These results are consistent with previous reports [ 13 , 14 , 15 , 16 , 19 , 20 ]. Pneumonia/chronic pulmonary disease may be associated with CPE colonization or infection in the lung.…”

Section: Discussionsupporting

confidence: 94%

“…In the present study, we report a 3.8% prevalence of CPE among patients in an ICU, which is much higher than reports from Kor-GLASS, because the population in the present study comprised of patients admitted in ICU. The prevalence of this study is similar or lower compared to other regional reports: 12% in Israel, 5.4% in the USA, 6.6% in China, 12.2% in Japan, and 18.1% in India [ 12 , 13 , 14 , 15 , 16 ].…”

Section: Discussionsupporting

confidence: 81%

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Risk Factors for Carbapenemase-Producing Enterobacterales Infection or Colonization in a Korean Intensive Care Unit: A Case–Control Study

et al. 2020

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The purpose of this study is to identify the factors related to the infection and/or colonization of carbapenemase-producing Enterobacterales (CPE) based on clinical and microbiological data for patients in the intensive care unit (ICU). All patients admitted to medical ICU were screened for CPE on admission and weekly, and this 1:2 case–control study included patients with CPE identified by screening or clinical cultures from 2017 to 2018. The clonal relatedness was evaluated by pulsed-field gel electrophoresis (PFGE). A total of 45 CPE patients were identified with a prevalence of 3.8%. The most frequent organism was Klebsiella pneumoniae (69%) and the carbapenemases belonged to the class A Klebsiella pneumoniae Carbapenemase (KPC-2) (87%), class B New Delhi Metallo-β-lactamase (NDM) (11%), and Imipenemase (IMP-1) (2%) strains. The PFGE profiles showed two large clustered groups of KPC-2-producing K. pneumoniae. In the multivariate analysis, pneumonia/chronic pulmonary disease, previous fluoroquinolone use, and previous use of nasogastric tube were the significant risk factors for CPE infection or colonization in ICU-admitted patients. Critical illness and underlying medical conditions such as pneumonia/chronic pulmonary disease, antimicrobial selective pressure, and the use of a medical device are identified as risk factors for CPE infection or colonization in ICU. Person to person transmission also contributed.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 81%

Risk Factors for Carbapenemase-Producing Enterobacterales Infection or Colonization in a Korean Intensive Care Unit: A Case–Control Study

et al. 2020

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“…Screening of rectal swab specimens for CR-GNB carriage at the time of ICU admission may help to identify patients who require isolation or who are at high risk of developing endogenous infections and require frequent monitoring during their ICU stay. CR-GNB colonization among patients admitted to an ICU has previously been studied, and various carriage rates have been reported (10)(11)(12)(13)(14)(15). In the present study, we found that 11.6% and 9.5% of patients admitted to ICUs were colonized with CR-GNB and CP-GNB, respectively.…”

Section: Discussionsupporting

confidence: 58%

Risk Factors for Gastrointestinal Colonization and Acquisition of Carbapenem-Resistant Gram-Negative Bacteria among Patients in Intensive Care Units in Thailand

Kiddee

Assawatheptawee

Na-udom

et al. 2018

Antimicrob Agents Chemother

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This study was conducted to investigate the prevalence of and risk factors for colonization and acquisition of carbapenem-resistant (CR) Gram-negative bacteria (GNB) among patients admitted to intensive care units (ICUs) in two tertiary care hospitals in northern Thailand. Screening of rectal swab specimens for CR-GNB was performed on patients at ICU admission and discharge. The phenotypes and genotypes of all isolates were determined. Risk factors were analyzed by logistic regression analysis. The overall carriage rate of CR-GNB at admission was 11.6% (32/275), with the most predominant species carried being ( = 15), followed by ( = 9). The risk factor for CR-GNB colonization was hospitalization within the previous 6 months ( = 0.002). During the ICU stay, the rate of CR-GNB acquisition was 25.2% (52/206), with the most predominant species carried being ( = 28) and ( = 13). Risk factors associated with CR-GNB acquisition were the use of an enteral feeding tube ( = 0.008) and administration of third-generation cephalosporins ( = 0.032) and carbapenems ( = 0.045). The most common carbapenemase genes in and were and, respectively. Patient-to-patient transmission was demonstrated in three cases, resulting in the acquisition of CR (2 cases) and (1 case) isolates from other patients who were admitted during the same period of time. This is the first Indochinese study screening patients, examining patients for the carriage of CR-GNB, and further demonstrating the transfer of CR-GNB isolates in ICUs. Our study suggests that effective infection control measures are required to limit the spread of CR-GNB within hospitals.

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“…However, this study re-asserts the central role of intra-and inter-hospital transmission for the most burdensome carbapenemase-positive clones that are already well-established within the human population. Indeed, strong links between hospital care and the acquisition of carbapenem-non-susceptible bacteria have previously been noted [14,[25][26][27][28], and the impact of community [29] or animal and environmental reservoirs [10] on clinical cases remains circumstantial. In this context, we note that a large faecal resistome analysis from slaughter pigs and broilers failed to identify carbapenemase genes in 181 pig and 178 poultry farms from nine European countries [30].…”

Section: Discussionmentioning

confidence: 99%

Epidemic of carbapenem-resistant Klebsiella pneumoniae in Europe is driven by nosocomial spread

David¹,

et al. 2019

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Fecal Carriage of Carbapenem-Resistant Enterobacteriaceae and Risk Factor Analysis in Hospitalised Patients: A Single Centre Study from India

Abstract: The study is the first from India to show high CRE carriage in patients admitted to a tertiary care centre and emphasises the need of strict antimicrobial stewardship implementation in hospitals to prevent dissemination of multidrug-resistant CRE.

Cited by 32 publications

References 31 publications

Risk Factors for Carbapenemase-Producing Enterobacterales Infection or Colonization in a Korean Intensive Care Unit: A Case–Control Study

Risk Factors for Carbapenemase-Producing Enterobacterales Infection or Colonization in a Korean Intensive Care Unit: A Case–Control Study

Risk Factors for Gastrointestinal Colonization and Acquisition of Carbapenem-Resistant Gram-Negative Bacteria among Patients in Intensive Care Units in Thailand

Epidemic of carbapenem-resistant Klebsiella pneumoniae in Europe is driven by nosocomial spread

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