<p>Epidemiology of carbapenem-resistant Enterobacteriaceae: a 5-year experience at a tertiary care hospital</p>

Abstract

Purpose The incidence of carbapenem-resistant Enterobacteriaceae (CRE) has been increasing worldwide. Ertapenem resistance is mediated by non-carbapenemase mechanisms, and has less of an effect on susceptibility to imipenem and meropenem. This study aimed to study the epidemiology of CRE, and to compare risk factors and related mortality between non-susceptibility to ertapenem alone Enterobacteriaceae (NSEE), with non-susceptibility to other carbapenems (imipenem, meropenem, or doripenem) Enterobacteriaceae (NSOCE) at a tertiary care hospital in Thailand. Methods All CRE isolated were identified between December 2011 and December 2016. Quarterly incidence rate was estimated. Hospital-wide carbapenem consumption was calculated as defined daily doses (DDD). Relationships between hospital-wide carbapenem consumption and incidence of CRE were tested. Factors associated with NSEE and NSOCE, and risk factors associated with 14- and 30-day mortality in patients with CRE infection were determined. Results The quarterly CRE incidence increased significantly from 3.37 per 100,000 patient-days in the last quarter of 2011 to 32.49 per 100,000 patient-days in the last quarter of 2016. ( P for trend <0.001). Quarterly hospital-wide carbapenem consumption increased 1.58 DDD per 1,000 patient-days ( P for trend=0.004). The Poisson regression showed the expected increase of CRE incidence was 1.02 per 100,000 patient-days for a 1 DDD per 1,000 patient-days increase in carbapenem consumption ( P <0.001). There were 40 patients with NSEE and 134 patients with NSOCE in the 5-year study period. The NSEE group had significantly lower carbapenem exposure compared with the NSOCE group (adjusted odds ratio: 0.25; P =0.001). No difference in 14-day and 30-day all-cause mortality between the two groups was observed. Conclusion The incidence of CRE has risen significantly at our institution. Previous carbapenem use was associated with NSOCE. This hospital-wide carbapenem use was significantly associated with the increasing incidence of CRE.

Carbapenem-Resistant Enterobacteriaceae Posing a Dilemma in Effective Healthcare Delivery

“…The prevalence of CRE among inpatients 11.11% (17/153) was more when compared to that among outpatients 3.27% (5/153) in the hospital. This also shows that CRE can be both hospital and community acquired and that the transmission of CRE infection is more likely in hospitals [20][21][22].…”

“…While our study showed that of the factors investigated, only literacy levels (p value = 0.0058) and hospitalization (p value < 0.0001) actually affected the rate of CRE infections; the infection rates of enterobacteriaceae generally were found to be affected by factors such as age, marital status, level of education and hospital setting. Other studies proved that younger age group and hospitalization are common risk factors for Gram-negative enterobacteriaceae (GNE) infections [18,19] while hospitalization remains the leading cause of CRE infections [20][21][22]. Since hospitalization is a strong risk factor in CRE colonization; clinicians, other health workers and in fact, everyone should join hands to reduce patients' length of stay in hospitals as this will reduce the risk of spread of CRE as well as control them.…”

Prolonged Carriage of Carbapenemase-Producing Enterobacteriaceae: Clinical Risk Factors and the Influence of Carbapenemase and Organism Types

“…Although there is a paucity of data for evaluating the impact of individual antibiotics on the intestinal microbiota [ 38 , 39 ], a recent publication showed that carbapenem use was independently predictive of high relative abundance of KPC-producing K. pneumoniae in the gut microbiota [ 40 ]. Interestingly, one epidemiologic study revealed that the incidence of CRE may rise with increased hospital-wide carbapenem use over time [ 41 ]. From our point of view, a multifaceted infection control program for CPE should include targeted carbapenem stewardship that has already been used in the control of CPE outbreaks [ 2 ].…”

<p>Risk Factors for Subsequential Carbapenem-Resistant <em>Klebsiella pneumoniae</em> Clinical Infection Among Rectal Carriers with Carbapenem-Resistant <em>Klebsiella pneumoniae</em></p>

“…[6][7][8][9] CRKPs are often extremely drug resistant to most available antimicrobial agents and associated with high morbidity and mortality, as well as high cost. 10 Thus, appropriate measures to control their infections are in urgent need.…”