Risk factors for carbapenem-resistant Enterobacteriaceae infections: a French case-control-control study

Abstract

This study aimed to assess characteristics associated with infections due to carbapenem-resistant Enterobacteriaceae (CRE), producing (CPE) or not producing (non-CPE) carbapenemase, among hospitalised patients in 2014-2016 in France. Casepatients with CRE were compared to two control populations. In multivariate analysis comparing 160 CRE cases to 160 controls C1 (patients with a clinical sample positive for carbapenem-susceptible Enterobacteriaceae), five characteristics were linked to CRE: male gender (OR = 1.9; 95% CI = 1.3-3.4), travel in Asia (OR = 10.0; 95% CI = 1.1-91.2) and hospitalisation in (OR = 2.4; 95% CI = 1.3-4.4) or out of (OR = 4.4; 95% CI = 0.8-24.1) France in the preceding 12 months, infection in the preceding 3 months (OR = 3.0; 95% CI = 1.5-5.9), and antibiotic receipt between admission and inclusion (OR = 1.9; 95% CI = 1.0-3.3). In multivariate analysis comparing 148 CRE cases to 148 controls C2 [patients with culture-negative sample(s)], four characteristics were identified: prior infection (OR = 3.3; 95% CI = 1.6-6.8), urine drainage (OR = 3.0; 95% CI = 1.5-6.1) and mechanical ventilation (OR = 3.7; 95% CI = 1.1-13.0) during the current hospitalisation, and antibiotic receipt between admission and inclusion (OR = 6.6; 95% CI = 2.8-15.5). Univariate analyses comparing separately CPE cases to controls (39 CPE vs C1 and 36 CPE vs C2) and non-CPE cases to controls (121 non-CPE vs C1 and 112 non-CPE vs C2), concomitantly with comparison of CPE to non-CPE cases showed that only CPE cases were at risk of previous travel and hospitalisation abroad. This study shows that, among CRE, risk factors are different for CPE and non-CPE infection, and suggests that question patients about their medical history and lifestyle should help for early identification of patients at risk of CPE among patients with CRE.

Risk factors and outcomes of patients colonized with carbapenemase-producing and non–carbapenemase-producing carbapenem-resistant Enterobacteriaceae

“…On univariate analysis, as in previous studies, [9][10][11]17,[21][22][23] we found that risk factors for both CP-CRE colonization and non-CP-CRE colonization included nursing home residency before hospital admission, antibiotic treatment 3 months before admission, urinary catheter, decubitus ulcer, and mechanical ventilation. We did not find men to be at an increased risk for CP-CRE or non-CP-CRE colonization in comparison to other studies, 9,10 which may have been due to an older patient population in our study and the longer life expectancy of women in Israel.…”

“…Glucocorticosteroids are immunosuppressive agents that may lead to downregulation of the immune system, which might be followed by a higher incidence of infectious complications in patients receiving glucocorticosteroids. 25 A previous study from France 21 addressing risk factors for CP-CRE compared to non-CP-CRE infections found that only CP-CRE cases were associated with previous travel and hospitalization abroad; other risk factors were the same for both groups. We did not evaluate previous travel and hospitalization abroad in our patient population because both CP-CRE and non-CP-CRE are prevalent in our region.…”

“…CRE resistance can be divided into 2 major groups: CP-CRE and non-CP-CRE. Previous studies [9][10][11][12][17][18][19][20][21][22][23][24] have addressed the issue of risk factors for CRE colonization/infection as a whole (ie, 1 group), showing that the following factors were associated with CRE acquisition: male sex, nursing home residency before hospital admission, history of admission within 1 year, poor functional status, Charlson index score ≥3, urinary catheter, decubitus ulcer, mechanical ventilation, intensive care unit stay, undergoing an invasive procedure with a scope device, and prior antibiotic exposure including penicillins, cephalosporins, carbapenems, vancomycin and fluoroquinolones.…”

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.…”