Active case finding for carbapenemase-producing Enterobacteriaceae in a teaching hospital: prevalence and risk factors for colonization

Poole, K; George, Ryan; Decraene, Valérie; Shankar, K; Cawthorne, Julie; Savage, N; Welfare, William; Dodgson, Andrew

doi:10.1016/j.jhin.2016.06.019

Cited by 33 publications

(19 citation statements)

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“…In contrast to previous studies, the presence of invasive devices was not associated with the presence of CPE [9,[17][18][19]. A long hospital stay was already reported to be a risk factor for CPE acquisition in other studies [11,30]. Even though the previous length of stay in hospitals other than VGH was not investigated, almost half of the patients (41.3%) were admitted at ICUs for long periods, thus reflecting both, their critical conditions and need of life supporting procedures.…”

Section: Discussionmentioning

confidence: 60%

“…The principal limitation of the current study is the retrospective design. Due to the control group matching criteria, the difference in age between CPE patients and the control group was not investigated, even though higher age had been identified as a risk factor for CPE carriage in other studies [11,36].…”

Section: Discussionmentioning

confidence: 99%

“…A total of 177 patients served as controls. The following variables identified in literature as risk factors for CPE acquisition [9][10][11][12][13][14][15][16][17][18][19] h. Contact with healthcare system of countries with high or unknown carbapenem-resistant enterobacteriaceae prevalence.…”

Section: Case-control Study To Identify Risk Factorsmentioning

confidence: 99%

“…Perception of risk factors for CPE is important to install a targeted screening strategy of patients at risk, to implement appropriate infection control measures and, if necessary, empiric antimicrobial therapy. To date, prior antimicrobial exposure, the length of hospital stay, the presence of invasive devices, advanced age and severe underlying diseases were identified as independent risk factors for CPE carriage [9][10][11][12][13][14][15][16][17][18][19]. Recent studies have focused on investigating CPE colonization of patients in cross-border transfers, but these results are debatable due to paucity of evidence [17,[20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

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Infection control and risk factors for acquisition of carbapenemase-producing enterobacteriaceae. A 5 year (2011–2016) case-control study

Lusignani

Presterl

Zatorska

et al. 2020

Antimicrob Resist Infect Control

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Background: Carbapenemase-producing enterobacteriaceae (CPE) are a major threat for severely ill patients. However, only limited data on the epidemiology and on evidence-based infection prevention and control measures are available. The aim of this study was to investigate the epidemiology of patients with CPE, characterizing the CPE isolates by their resistance mechanisms and genetic similarity, to explore risk factors for their acquisition, and to evaluate the effectiveness of the current CPE infection control measures. Methods: A retrospective case-control study was performed using data from 2011 to 2016 in a 1800-bed academic hospital in Central Europe, where risk-based screening at patients´admission is performed. Carbapenem resistance mechanisms of all carbapenem resistant enterobacteriaceae from patients admitted during this period were investigated. Clinical data of the CPE-positive patients were analysed and compared to a matched control group (case-control ratio of 1:3). We performed univariate and multivariate statistical analysis to identify risk factors for CPE acquisition. Results: Of 621,623 admitted patients in the study period, 75 patients with carriage of carbapenem resistant enterobacteriaceae were included (0.12/1000 admittances). Carbapenemase-encoding genes were detected in 77.3% (58/75) of patients with carbapenem-resistant enterobacteriaceae. The enzyme blaOXA-48 was found in 34.5% (20/58), blaKPC in 29.3% (17/58), blaNDM enzymes in 20.7% (12/58) and blaVIM in 8.6% (5/58) of the isolates. The overall mortality among CPE patients was 25.9% (15/58) and attributable mortality of CPE was 53.3% (8/15). Multivariate analysis revealed four risk factors to be independent predictors of CPE carriage: the length of hospital admission > 20 days (AOR: 4.9, 95% CI: 1.4-15.5; P < 0.001), hospital admission within the previous year (AOR: 22.3, 95% CI: 3.9-88.4; P < 0.001), exposure to a healthcare facility in a country with high or unknown carbapenemresistant enterobacteriaceae prevalence 3 months before admission (AOR: 11.8, 95% CI: 2.2-63.2; P < 0.01) and the use of antibiotics longer than 10 days (AOR: 5.2, 95% CI: 1.4-35.9; P < 0.05). The current risk-based screening strategy at hospital admission could not identify 37 (63.8%) of the 58 CPE-positive patients. Epidemiological investigation and genotyping revealed that no outbreaks due to CPE occurred during this period. Conclusion: Overall, the CPE carriage rate in patients was very low, the attributable mortality, however, is alarming (53%). BlaOXA-48 and blaKPC were the main cause of carbapenem resistance in enterobacteriaceae. Although the strict application of standard infection control measures was effective for prevention of outbreaks in this setting, an enlarged risk based targeted screening strategy has to be implemented.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Case-control Study To Identify Risk Factorsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Infection control and risk factors for acquisition of carbapenemase-producing enterobacteriaceae. A 5 year (2011–2016) case-control study

Lusignani

Presterl

Zatorska

et al. 2020

Antimicrob Resist Infect Control

View full text Add to dashboard Cite

show abstract

“…A prevalência de infecções com ocorrência de KPC, na população de adultos internados em hospital com condições clínicas infecciosas, foi estimada em aproximadamente 12% do total de internações por infecções no Brasil (Marra et al, 2011). Essa prevalência encontrada no Brasil é compatível com a literatura internacional (Poole et al, 2016). As internações por infecções em geral representam 10% do total de internações, conforme dados do Datasus.…”

Section: Prevalênciasunclassified