Carbapenemase-producing Enterobacteriaceae: Risk factors for infection and impact of resistance on outcomes

Abstract

Background:Carbapenemase-producing Enterobacteriaceae (CPE) have increased in recent years leading to limitations of treatment options. The present study was undertaken to detect CPE, risk factors for acquiring them and their impact on clinical outcomes.Methods:This retrospective observational study included 111 clinically significant Enterobacteriaceae resistant to cephalosporins subclass III and exhibiting a positive modified Hodge test. Screening for carbapenemase production was done by phenotypic methods, and polymerase chain reaction was performed to detect genes encoding them. Retrospectively, the medical records of the patients were perused to assess risk factors for infections with CPE and their impact. The data collected were duration of hospital stay, Intensive Care Unit (ICU) stay, use of invasive devices, mechanical ventilation, the presence of comorbidities, and antimicrobial therapy. The outcome was followed up. Univariate and multivariate analysis of the data were performed using SPSS software.Results:Carbapenemase-encoding genes were detected in 67 isolates. The genes detected were New Delhi metallo-β-lactamase, Verona integron-encoded metallo-β-lactamase, and oxacillinase-181.Although univariate analysis identified risk factors associated with acquiring CPE infections as ICU stay (P = 0.021), mechanical ventilation (P = 0.013), indwelling device (P = 0.011), diabetes mellitus (P = 0.036), usage of multiple antimicrobial agents (P = 0.007), administration of carbapenems (P = 0.042), presence of focal infection or sepsis (P = 0.013), and surgical interventions (P = 0.016), multivariate analysis revealed that all these factors were insignificant. Mortality rate was 56.7% in patients with CPE infections. By both univariate and multivariate analysis of impact of the variables on mortality in these patients, the significant factors were mechanical ventilation (odds ratio [OR]: 0.141, 95% confidence interval [CI]: 0.024–0.812) and presence of indwelling invasive device (OR: 8.034; 95% CI: 2.060–31.335).Conclusion:In this study, no specific factor was identified as an independent risk for acquisition of CPE infection. However, as it is evident by multivariate analysis, there is an increased risk of mortality in patients with CPE infections when they are ventilated and are supported by indwelling devices.

Epidemiological profile of healthcare-associated infections caused by Carbapenemase-producing Enterobacteriaceae

“…The mean age of the study groups was 71 years, well above the data in the literature, which ranged from 49 to 64 years (16)(17)(18) . In this case, the high age was mainly attributed to the profile of patients attended at the institution: chronic, with the need for semi-intensive care and who remained hospitalized for a longer time.…”

“…In this case, the high age was mainly attributed to the profile of patients attended at the institution: chronic, with the need for semi-intensive care and who remained hospitalized for a longer time. However, the prevalence of males, marital status, skin color and education did not obtain a specific explanation in the literature regarding infectious events (16,19) .…”

“…It is inferred that the HAI topography, as well as the limitation to the antimicrobial treatments received during the hospitalization period have a strong impact on the evolution of the patient's death. In addition, aspects related to the complexity of the microorganism, the severity of the patient, as well as their comorbidities influence the high lethality rate (16)(17)(18)22) .…”

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

“…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.…”

“…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].…”