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

Abstract

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.

Prior Antibiotic Therapy and the Onset of Healthcare-Associated Infections Sustained by Multidrug-Resistant Klebsiella pneumoniae in Intensive Care Unit Patients: A Nested Case–Control Study

“…This is in line with Mantzarlis et al [ 35 ], who found similar results for the two different ways to account for antibiotic exposure. In addition, we were not able to demonstrate an effect of other antibiotic classes often associated with CR or/ and ESBL Kp in the literature [ 15 ], such as carbapenems [ 16 , 21 , 36 , 37 , 38 ], fluoroquinolones [ 12 , 13 , 39 ], and extended-spectrum cephalosporins [ 13 , 14 , 39 ]. In our opinion, this may be due to the different study designs or outcomes of these studies, mostly investigating temporal trend association or colonization, together with infections.…”

Appropriate sites for the active surveillance of carbapenemase-producing Enterobacteriaceae

“…First, the analysis was performed in a single tertiary care hospital, and most of the enrolled patients had undergone a liver transplantation. Because such cases involve the use of several different medical devices, require mechanical ventilation, and have a higher risk of exposure to antimicrobial agents and thus they have a greater risk of CPE colonization than the general population [11,12]. Second, we did not perform genetic analyses of the CPE strains to compare the isolates from close contact patients and index cases.…”

OXA-48 Carbapenemase-Producing Enterobacterales in Spanish Hospitals: An Updated Comprehensive Review on a Rising Antimicrobial Resistance

“…As discussed above, admission to ICU is a risk factor for acquiring these strains, probably due to several reasons, such as long-term ventilator use [ 93 ], antibiotic pressure or presence of CREs or plasmids in the ICU area. A recent case-control study performed in Korea [ 94 ] showed that pneumonia/chronic pulmonary disease, previous fluoroquinolone use and previous use of nasogastric tube were the significant risk factors for CRE infection or colonization in ICU-admitted patients, although no OXA-48-like CRE were identified in their study.…”