Carbapenem-resistant Enterobacteriaceae colonization and infection in critically ill patients: a retrospective matched cohort comparison with non-carriers

Dickstein, Yaakov; Edelman, Ravit; Dror, Tali; Hussein, Khetam; Bar-Lavie, Yaron; Paul, Mical

doi:10.1016/j.jhin.2016.05.018

Cited by 73 publications

(64 citation statements)

References 33 publications

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“…However, previous studies have shown that there is a strong correlation between colonisation with CRE and HAI caused by CRE. [12][13][14] In this paper we report an epidemic spread of CRE on 63 wards in 12 Vietnamese hospitals. Colonisation of hospitalised patients is rapid, increasing for each day of hospitalisation.…”

Section: Main Findingsmentioning

confidence: 83%

“…10 Except for improvement in IPC measures, development of new antibiotics active against CRE are urgently needed. 10 , 11 There is a strong correlation between colonisation with CRE and hospital-acquired infections (HAI) caused by CRE [12][13][14] and it has been shown that CRE colonisation and subsequent infection is associated with increased mortality. 15 , 16 High rates of infections caused by extended-spectrum βlactamase-(ESBL A + M ) producing Enterobacteriaceae, resistant to 3rd generation cephalosporin, but susceptible to carbapenems, have been reported during many years in Southeast Asia.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

High prevalence of colonisation with carbapenem-resistant Enterobacteriaceae among patients admitted to Vietnamese hospitals: Risk factors and burden of disease

Tran

Larsson

Olson

et al. 2019

Journal of Infection

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Section: Main Findingsmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

High prevalence of colonisation with carbapenem-resistant Enterobacteriaceae among patients admitted to Vietnamese hospitals: Risk factors and burden of disease

Tran

Larsson

Olson

et al. 2019

Journal of Infection

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“…pneumoniae carriers subsequently developed infections [4, 5]. Mortality in ICU CRE carriers was high and ranged between 26 to 41% [5, 18, 19]. However, variability in CRE organisms, study population and study design (e.g.…”

Section: Introductionmentioning

confidence: 99%

Carbapenem-resistant Enterobacteriaceae colonization (CRE) and subsequent risk of infection and 90-day mortality in critically ill patients, an observational study

et al. 2017

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BackgroundCarbapenem-resistant Enterobacteriaceae (CRE) have emerged as an urgent public health threat. Intestinal colonization with CRE has been identified as a risk factor for the development of systemic CRE infection, but has not been compared to colonization with third and/or fourth generation cephalosporin-resistant (Ceph-R) Enterobacteriaceae. Moreover, the risk conferred by colonization on adverse outcomes is less clear, particularly in critically ill patients admitted to the intensive care unit (ICU).MethodsWe carried out a cohort study of consecutive adult patients screened for rectal colonization with CRE or Ceph-R upon ICU entry between April and July 2013. We identified clinical variables and assessed the relationship between CRE or Ceph-R colonization and subsequent systemic CRE infection within 30 days (primary outcome) and all-cause mortality within 90 days (secondary outcome).ResultsAmong 338 ICU patients, 94 (28%) were colonized with either Ceph-R or CRE. 26 patients developed CRE infection within 30 days of swab collection; 47% (N = 17/36) of CRE-colonized and 3% (N = 2/58) of Ceph-R colonized patients. 36% (N = 13/36) of CRE-colonized patients died within 90 days compared to 31% (N = 18/58) of Ceph-R-colonized and 15% (N = 37/244) of non-colonized patients. In a multivariable analysis, CRE colonization independently predicted development of a systemic CRE infection at 30 days (aOR 10.8, 95% CI2.8–41.9, p = 0.0006); Ceph-R colonization did not (aOR 0.5, 95% CI0.1–3.3, p = 0.5). CRE colonization was associated with increased 90-day mortality in a univariable analysis (p-value 0.001), in a multivariable model, previous hospitalization and medical ICU admission were independent predictors of 90-day mortality whereas CRE colonization approached significance (aOR 2.3, 95% CI1.0–5.3, p = 0.056).ConclusionsOur study highlights the increased risk of CRE infection and mortality in patients with CRE colonization at the time of ICU admission. Future studies are needed to assess how CRE colonization can guide empiric antibiotic choices and to develop novel decolonization strategies.

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“…Additionally, it is worth noting that of the patients who were positive in continuous screening, only 4 were positive at the first screening, and 80.9% (17 out of 21 colonized patients) turned positive results for CRE at the second or later screening, which again suggests the deficiencies of single screening. Moreover, due to the increased positive rate of continuous screening and the preemptive treatments used in these patients with infectious symptoms, the morbidity and mortality of CRE The patient 1:single screening was negative for the patient, but subsequent screening indicated positive 3 days after the onset of fever and the patient died of septic shock 1.Four patients (2,12,20,23) were combined with polymyxin because of persistent fever after 48 h of tigecycline treatment, one of them (patient 20) developed CRE BSIs later…”

Section: Discussionmentioning

confidence: 99%

“…Gut colonization by CRE is an independent risk factor for CRE infection [7,8,11,12]. An Italian multicenter study showed that in patients who underwent autologous and allogeneic HSCT, the CRE colonization rates were 1 and 2.4%, respectively.…”

Section: Introductionmentioning

confidence: 99%

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

Yang

Luo

Yang

et al. 2020

Antimicrob Resist Infect Control

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Background: A consensus has been reached that carbapenem-resistant Enterobacteriaceae (CRE) screening in immunosuppressed individuals can reduce the incidence of CRE bloodstream infection (BSI). Methods:We retrospectively studied the clinical data of 395 consecutive HSCT patients from (period 2), 195 patients received continuous weekly CRE screening after admission. For patients colonized with CRE, targeted managements were received: (1) contact precautions and (2) preemptive CRE-targeted treatment if necessary. Results: During period 1, 3 patients with CRE colonization were detected (1.5%). The CRE BSI rate was 2.0% (4 patients), and the related 30-day mortality was 50.0% (2 out of 4 patients). During period 2, 21 patients with CRE colonization were detected, and the detection rate was significantly higher than that in period 1 (P < 0.001). Of the 21 colonized patients, 4 (19.0%) patients were identified as positive for CRE at the first screening, 5 (23.8%) were identified at the second screening, and the remaining 12 (57.1%) were identified at the third or later screening. The CRE BSI rate decreased to 0.5% (1/195), and there were no CRE-related death. Fifteen colonized patients developed neutropenic fever. Thirteen colonizers were preemptively treated with tigecycline within 24 h of fever onset, and they achieved rapid temperature control. One colonizer received tigecycline later than 48 h after fever onset and ultimately survived due to the addition of polymyxin. The other received tigecycline later than 72 h after fever onset and died of septic shock. Conclusion:The increase in screening frequency contributed to the detection of patients with CRE colonization. Targeted managements for these colonized patients may contribute to reducing the incidence and mortality of CRE BSI, therefore improving the prognosis of patients.

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Carbapenem-resistant Enterobacteriaceae colonization and infection in critically ill patients: a retrospective matched cohort comparison with non-carriers

Cited by 73 publications

References 33 publications

High prevalence of colonisation with carbapenem-resistant Enterobacteriaceae among patients admitted to Vietnamese hospitals: Risk factors and burden of disease

High prevalence of colonisation with carbapenem-resistant Enterobacteriaceae among patients admitted to Vietnamese hospitals: Risk factors and burden of disease

Carbapenem-resistant Enterobacteriaceae colonization (CRE) and subsequent risk of infection and 90-day mortality in critically ill patients, an observational study

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

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