Risk factors for rectal colonization of carbapenem-resistant Enterobacteriaceae in a tertiary care hospital: a case-control study from Turkey

Abstract

Background/aim This study aimed to evaluate the risk factors of patients colonized with carbapenem-resistant Enterobacteriaceae (CRE). Materials and methods The study was conducted between January 2010 and March 2016. The colonized group consisted of patients who had a CRE strain in their rectal swab cultures, whereas patients with negative rectal surveillance cultures for CRE who were concurrently hospitalized in the same units with the colonized group patients were included in the control group. Results The number of patients in the colonized and the control group was 71 and 120, respectively. Both groups were evaluated for demographic and healthcare-associated characteristics. Isolated microorganisms in rectal surveillance cultures for CRE were Klebsiella pneumoniae (75.5%), Escherichia coli (15.5%), Enterobacter cloacae (4.2%), Klebsiella oxytoca (1.4%), and Klebsiella terrigena (1.4%). The isolates were resistant to imipenem, meropenem, and ertapenem (52.1%, 73.2%, and 100%, respectively). In multivariate analysis, presence of decubitus, colistin usage, glycopeptide usage, and fluoroquinolone usage were found to be independent risk factors for CRE colonization. There was no significant difference between the two groups with regards to mortality (P = 0.070). Conclusion These results are in agreement with the current literature. The findings of this study could be useful for improvement of infection control strategies related to 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.…”

“…On multivariate analysis, as in previous studies, 11,23 we demonstrated that predictors for CP-CRE colonization and for non-CP-CRE colonization included nursing home residency before hospital admission, antibiotic treatment 3 months before admission, and having a decubitus ulcer. In our study, risk factors unique for non-CP-CRE colonization (and not for CP-CRE colonization) included mechanical ventilation and patient movement between various hospital departments.…”

“…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.…”

Raoultellaterrigena: Current state of knowledge, after two recently identified clinical cases in Eastern Europe

“…Like Klebsiella, Raoultella can acquire antibiotic resistance genes, leading to an increase of the multidrug‐resistant (MDR) isolates. Recent work describing infections caused by Raoultella has shown that these bacteria are characterized by various resistance mechanisms, especially those involving sulfonamides and quinolone and antibiotics of the β ‐lactam spectrum 12,13 . Resistance genes for such drugs are localized in bacterial plasmids; they are not a constitutive component of their genome.…”

Karbapenemaz üreten Enterobactericea üyelerinin saptanmasında CHROMagar besiyeri ile RAPIDEC ® CARBA NP testin performansının karşılaştırılması

“…Karbapeneme dirençli Enterobacteriaceae ailesi üyelerinin neden olduğu enfeksiyonlar Türkiye' de ve tüm dünyada önemli bir sorundur (1)(2)(3)(4). Karbapenem direnci;…”