How frequently are hospitalized patients colonized with carbapenem-resistant Enterobacteriaceae (CRE) already on contact precautions for other indications?

Goodman, Katherine E; Simner, Patricia J.; Klein, Eili Y.; Kazmi, Abida Q.; Gadala, Avinash; Rock, Clare; Cosgrove, Sara E.; Maragakis, Lisa L.; Milstone, Aaron M.

doi:10.1017/ice.2018.236

Cited by 12 publications

(12 citation statements)

References 7 publications

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“…Risk factors for CRE colonization are numerous. Previous studies reported that severe underlying diseases, previous ICU hospitalization, long hospital stay, more invasive procedures, recent surgical history, previous infection history, long-term antibiotic use, long-term glucocorticoid use, and undergoing a transplant were risk factors for CRE colonization [15,[26][27][28][29]. However, in our study, no statistical signi cance in terms of the history of ICU hospitalization, invasive procedures, and steroid use between colonization and the non-colonization groups was found.…”

Section: Discussioncontrasting

confidence: 84%

Risk Factors and Molecular Epidemiology of Fecal Carriage of Carbapenem Resistant Enterobacteriaceae in Patients with Liver Disease

Tian

Wang

et al. 2022

Preprint

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Background Carbapenem resistant Enterobacteriaceae (CRE) colonization is a risk factor for CRE infection. CRE infection results in an increase in mortality in patients with cirrhosis. However, minimal data regarding the prevalence of CRE colonization in patients with liver disease yet without liver transplantation are available. The present study aimed to investigate risk factors and molecular epidemiology characteristics of CRE fecal carriage among patients with liver disease. Methods Stool specimens from 574 adult inpatients with liver disease were collected from December 2020 to April 2021. CRE were screened using selective chromogenic agar medium and identified by the Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS). Antimicrobial susceptibility was determined using the broth microdilution method. Carbapenemase genes were characterized by polymerase chain reaction (PCR) and DNA sequencing. Multilocus sequence typing (MLST) was performed for Carbapenem Resistant Klebsiella pneumoniae (CR-KPN) isolates and Carbapenem Resistant Escherichia Coli (CR-ECO) isolates. Results The total number of stool specimens (732) were collected from 574 patients with liver disease. 43 non-duplicated CRE strains were isolated from 39 patients with a carriage rate of 6.79% (39/574). The carriage rate increased to 15.18% (17/112) in patients with acute-on-chronic liver failure (ACLF). Multivariate analysis indicated that ACLF (P = 0.022), the history of pulmonary infection within past 3 months (P = 0.001) and the use of third generation cephalosporin/β-lactamases inhibitor within past 3 months (P = 0.000) were independent risk factors of CRE colonization in patients with liver disease. Klebsiella Pnuemoniae (KPN) (51.28%) and Escherichia coli (ECO) (30.77%) were main strains in these patients. All CRE strains showed high resistance to most antibiotics except for polymyxin B and tigecycline. Most (83.72%, 36/43) of the CRE carried carbapenemase genes. blaKPC-2 was the major carbapenemase gene. The molecular epidemiology of KPN were dominated by ST11, while the STs of ECO were scattered. Conclusions The present study revealed the prevalence of CRE fecal carriage in patients with liver disease without liver transplantation. Regular CRE screening for hospitalized patients with liver disease should be conducted to limite the spread of CRE strain.

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Section: Discussioncontrasting

confidence: 84%

Risk Factors and Molecular Epidemiology of Fecal Carriage of Carbapenem Resistant Enterobacteriaceae in Patients with Liver Disease

Tian

Wang

et al. 2022

Preprint

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“…29 Consistent with the previous reports, CRE colonization in patients from community settings was infrequent. Healthcare facilities are usually considered as reservoirs of transmission 30 of CRE, and the healthcare providers are partly to blame in CRE acquisition among hospitalized patients. 31 Moreover, antibiotic exposures and invasive practices such as mechanical ventilation, percutaneous intervention and surgery increase the probability of CRE colonization and infection, 32,33 and more than half CRE colonizers had such experiences before CRE being detected in this study.…”

Section: Discussionmentioning

confidence: 99%

Fecal Carriage and Molecular Epidemiology of Carbapenem-Resistant Enterobacteriaceae from Inpatient Children in a Pediatric Hospital of Shanghai

Pan

Sun

et al. 2020

IDR

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“…As clinical cultures alone identify only a fraction of CRE patients [5], the majority of unrecognized CRE patients, a potential source of CRE transmission, might not be following contact precautions [1]. However, as a limited application of AST may increase the risk of missing unrecognized CRE patients, early detection of patients at high risk of CRE acquisition at hospital unit admission has been emphasized [6]. A few studies have identified the risk factors of model to assess the patients at high risk of CRE acquisition [7e9].…”

Section: Introductionmentioning

confidence: 99%

Development of a Nomogram for Carbapenem-Resistant Enterobacteriaceae Acquisition Risk Prediction Among Patients in the Intensive Care Unit of a Secondary Referral Hospital

Seo

Jeong

Song

et al. 2021

Asian Nursing Research

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This study aimed to identify the risk factors of carbapenem-resistant Enterobacteriaceae (CRE) acquisition to build a nomogram for CRE acquisition risk prediction and evaluate its performance. Methods: This unmatched case-control study included 352 adult patients (55 patients and 297 controls) admitted to the intensive care unit (ICU) of a 453-bed secondary referral hospital between January 1, 2018, and September 31, 2019, in Busan, South Korea. The nomogram was built with the identified risk factors using multiple logistic regression analysis. Its performance was analyzed using calibration-in-thelarge, the slope of the calibration plot, concordance statistic (c-statistic), and the sensitivity and specificity of the training set, subsets, and a new test set. Results: The risk factors of CRE acquisition among ICU patients at a secondary referral hospital were Acute Physiology and Chronic Health Evaluation II score at the time of admission, use of a central venous catheter and a nasogastric tube, as well as use of cephalosporin antibiotics. At 20.0% of the predicted CRE acquisition risk in the training set, the calibration-in-the-large was 0, slope of the calibration plot was 1, c-statistic was .93, sensitivity was 85.5%, and specificity was 84.8%. The performance was relatively good in the subsets and new test set. Conclusion:The nomogram can be used to monitor the CRE acquisition risk for ICU patients who have a similar case mix to patients in the study hospitals. Future studies need to involve more rigorous methodology and larger samples.

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How frequently are hospitalized patients colonized with carbapenem-resistant Enterobacteriaceae (CRE) already on contact precautions for other indications?

Cited by 12 publications

References 7 publications

Risk Factors and Molecular Epidemiology of Fecal Carriage of Carbapenem Resistant Enterobacteriaceae in Patients with Liver Disease

Risk Factors and Molecular Epidemiology of Fecal Carriage of Carbapenem Resistant Enterobacteriaceae in Patients with Liver Disease

<p>Fecal Carriage and Molecular Epidemiology of Carbapenem-Resistant <em>Enterobacteriaceae</em> from Inpatient Children in a Pediatric Hospital of Shanghai</p>

Development of a Nomogram for Carbapenem-Resistant Enterobacteriaceae Acquisition Risk Prediction Among Patients in the Intensive Care Unit of a Secondary Referral Hospital

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