Risk Factors for Gastrointestinal Colonization and Acquisition of Carbapenem-Resistant Gram-Negative Bacteria among Patients in Intensive Care Units in Thailand

Abstract

This study was conducted to investigate the prevalence of and risk factors for colonization and acquisition of carbapenem-resistant (CR) Gram-negative bacteria (GNB) among patients admitted to intensive care units (ICUs) in two tertiary care hospitals in northern Thailand. Screening of rectal swab specimens for CR-GNB was performed on patients at ICU admission and discharge. The phenotypes and genotypes of all isolates were determined. Risk factors were analyzed by logistic regression analysis. The overall carriage rate of CR-GNB at admission was 11.6% (32/275), with the most predominant species carried being ( = 15), followed by ( = 9). The risk factor for CR-GNB colonization was hospitalization within the previous 6 months ( = 0.002). During the ICU stay, the rate of CR-GNB acquisition was 25.2% (52/206), with the most predominant species carried being ( = 28) and ( = 13). Risk factors associated with CR-GNB acquisition were the use of an enteral feeding tube ( = 0.008) and administration of third-generation cephalosporins ( = 0.032) and carbapenems ( = 0.045). The most common carbapenemase genes in and were and, respectively. Patient-to-patient transmission was demonstrated in three cases, resulting in the acquisition of CR (2 cases) and (1 case) isolates from other patients who were admitted during the same period of time. This is the first Indochinese study screening patients, examining patients for the carriage of CR-GNB, and further demonstrating the transfer of CR-GNB isolates in ICUs. Our study suggests that effective infection control measures are required to limit the spread of CR-GNB within hospitals.

Different screening frequencies of carbapenem-resistant Enterobacteriaceae in patients undergoing hematopoietic stem cell transplantation: which one is better?

“…In China, the overall annual CRE incidence is approximately 4 per 10,000 discharges, with the highest rates in some regions (0.15%) where CRE is highly endemic and causes a severe disease burden [22]. Active surveillance for CRE colonization as part of a multifactorial intervention is an effective strategy to decrease nosocomial CRE infection rate and CRErelated mortality [20,23,24]. CRE screening with stool is considered an effective method for surveillance of CRE colonization.…”

Different screening frequencies of carbapenem-resistant Enterobacteriaceae in patients undergoing hematopoietic stem cell transplantation: which one is better?

“…In China, the overall annual CRE incidence is approximately 4 per 10,000 discharges, with the highest rates in some regions (0.15%) where CRE is highly endemic and causes a severe disease burden [23]. Active surveillance for CRE colonization as part of a multifactorial intervention is an effective strategy to decrease nosocomial CRE infection rate and CRE-related mortality [24][25][26]. CRE screening with stool is considered an effective method for surveillance of CRE colonization.…”

Low Prevalence of Carbapenem-Resistant Klebsiella pneumoniae in Zabol, Southeast of Iran

“…16 CR isolates of K. pneumoniae are known to be associated with high mortality and morbidity rates due to limited available therapeutic alternatives, indicating the importance of detection strategies. [14][15][16][17][18] Based on the results of the current study, 3 (4.3%) K. pneumoniae isolates were CRKP among which two of them were blaNDM positive. Moreover, a comprehensive meta-analysis conducted to estimate the prevalence of CRKP in different provinces of Iran indicated that 11% of the isolated K. pneumoniae were CR, ranging from 0.004 in Tehran to 58% in Isfahan provinces.…”

“…15 These contradictory results may be related to the low quality of personal hygiene, [14][15][16][17][18] variable sample sizes, the indiscriminate use of antibiotics, poor infection control policies, and the presence of some risk factors like previous hospitalization and long-term staying at ICU. [14][15][16][17][18] The results of the current study further revealed that 4.3% of isolates were MBL enzymes positive using imipenem-EDTA combined disk test. Among them, two isolates were blaNDM positive while the other investigated resistance genes were not detected.…”

“…Class B beta-lactamases (i.e., blaVIM, blaIMP, blaNDM, and blaSPM), which include MBLs, are among the most essential mechanisms. [14][15][16][17][18][19] The findings of different independent studies demonstrated that plasmid-expressed blaNDM-1 gene encoding the NDM-1 metallo-β-lactamase is spreading worldwide. For example, different outbreaks of blaNDM producing isolates are reported from patients referring to hospitals in India, Pakistan, Bangladesh, Poland, the US, Canada, and Spain.…”