Risk Factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Acquisition Among Contacts of Newly Diagnosed CP-CRE Patients

Abstract

objective. Carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) are extremely drug-resistant pathogens. Screening of contacts of newly identified CP-CRE patients is an important step to limit further transmission. We aimed to determine the risk factors for CP-CRE acquisition among patients exposed to a CP-CRE index patient.methods. A matched case-control study was performed in a tertiary care hospital in Israel. The study population was comprised of patients who underwent rectal screening for CP-CRE following close contact with a newly identified CP-CRE index patient. Cases were defined as positive tests for CP-CRE. For each case patient, 2 matched controls were randomly selected from the pool of contacts who tested negative for CP-CRE following exposure to the same index case. Bivariate and multivariate analyses were conducted using conditional logistic regression.results. In total, 53 positive contacts were identified in 40 unique investigations (896 tests performed on 735 contacts) between October 6, 2008, and June 7, 2012. bla KPC was the only carbapenemase identified. In multivariate analysis, risk factors for CP-CRE acquisition among contacts were (1) contact with an index patient for ≥3 days (odds ratio [OR], 9.8; 95% confidence interval [CI], 2.0-48.9), (2) mechanical ventilation (OR, 4.1; 95% CI, 1.4-11.9), and (3) carriage or infection with another multidrug-resistant organism (MDRO; OR, 2.6; 95% CI, 1.0-7.1). Among patients who received antibiotics, cephalosporins were associated with a lower risk of acquisition.conclusions. Patient characteristics (ventilation and carriage of another MDRO) as well as duration of contact are risk factors for CP-CRE acquisition among contacts. The role of cephalosporins requires further study.

Prevalence, molecular epidemiology and intra-hospital acquisition of Klebsiella pneumoniae strains producing carbapenemases in an Italian teaching hospital from January 2015 to September 2016

“…We observed several outbreaks during the study period and the source of transmission was not always identified: contact with an index patient for 3 days is an independent risk factor for CP Enterobacteriaceae acquisition among contacts (Schwartz-Neiderman et al, 2016). In all cases a late acquisition of CPKP during hospitalization was demonstrated.…”

A Systematic Review and Meta-analyses of the Clinical Epidemiology of Carbapenem-Resistant Enterobacteriaceae

“…Glycopeptide use was also identified to be a risk factor for carbapenem-resistant P. aeruginosa (15,17) and ESBL-producing bacteria (18) acquisition. On the contrary, 4 out of 13 significant risk factors were also described to be protective against CRE acquisition by other authors: quinolone use (19), mechanical ventilation (20), cephalosporin use (21), and ICU admission (22). Kwak et al speculated that fluoroquinolone use was found to be a protective factor because this antibiotic was often given as a substitute for carbapenem or cephalosporin antibiotics (19).…”

Enterobacteriaceae infections in Saudi Arabia: a regression analysis

“…However, no significant differences in the mortality rates were observed based on the duration of treatment. Previous studies have reported various risk factors associated with CRE infections and patient deaths, such as antibiotic exposure, ICU stay, poor functional status, septic shock, dialysis, age >60 years, ventilation, presence of another multidrug-resistant organism, duration of contact, presence of central venous catheters, and receipt of immunosuppressive drugs (20,21). Logistic regression model performed in this study revealed the significant predictors were septic shock, Charlson index two and renal impairment.…”