Factors Associated to Prevalence and Incidence of Carbapenem-Resistant Enterobacteriaceae Fecal Carriage: A Cohort Study in a Mexican Tertiary Care Hospital

Abstract

BackgroundCarbapenem-resistant Enterobacteriaceae (CRE) infections have emerged as a serious threat to health worldwide. They are associated with increased morbidity and mortality and are capable of silently colonizing the gastrointestinal tract. Because of this, there is great interest to characterize the epidemiology of CRE carriage and acquisition in healthcare facilities. The aim of this study was to determine the prevalence and factors associated with CRE fecal carriage (CRE-fc), and risk factors for incident cases.Methods/ResultsA cohort study was conducted at a tertiary care hospital from January 1st to April 30th, 2014 during a CRE outbreak. Weekly rectal swabs were performed in patients considered at risk until discharge. CRE-fc prevalence was 10.9% (CI 95% 7.7–14.7) among 330 patients. Treatment with carbapenems (OR 2.54, CI 95% 1.15–5.62); transfer from an institution (OR 2.16, CI 95% 1.02–4.59); multi-drug resistant infection within the previous six months (OR 2.81, CI 95% 1.47–5.36); intensive care unit admission (OR 0.42, CI 95% 0.20–0.88); hematologic malignancy (OR 4.02, CI 95% 1.88–8.06); invasive procedures (OR 2.18, CI 95% 1.10–4.32); and sharing a room with a known CRE carrier (OR 3.0, CI 95% 1.43–6.31) were independently associated factors for CRE-fc. Risk factors associated with CRE-fc incidence were determined for 87 patients initially negative and with subsequent screening; the incidence rate was 2.5 cases, per 1000 person-years (CI 95% 1.5–3.9). Independently associated risk factors were carbapenem treatment (HR 2.68, CI 95% 1.03–6.98), hematologic malignancy (HR 5.74, 95% CI 2.46–13.4) and a mean daily colonization pressure ≥10% (HR 5.03, IC 95% 1.77–14.28). OXA-48-like (OXA-232) and CTX-M-15 were the predominantly identified mechanisms of resistance.ConclusionsWe found an elevated incidence and prevalence of CRE-fc in our hospital. Hematologic patients need to be considered a population at risk, and antibiotic stewardship along with infection control programs need to be improved to avoid nosocomial spread.

Fosfomycin trometamol in the prophylaxis of post‐kidney transplant urinary tract infection: A controlled, randomized clinical trial

“…enterobacteria in hospitalized patients and the appearance of carbapenem-resistant microorganisms after intensive use of piperacillin/tazobactam. [28][29][30] Hence, our findings in this controlled clinical trial are in clear contrast with reports of prophylaxis in patients undergoing urological procedures and in females with recurrent UTI in whom FOS has been proven superior. [31][32][33][34] During the study, our center had a higher UTI incidence than that in previous years.…”

“…observed during the study. Significantly, our group reported a concomitant outbreak in our hospital caused by a highly horizontally transmitted plasmid, resulting in great intestinal colonization by multidrug‐resistant enterobacteria in hospitalized patients and the appearance of carbapenem‐resistant microorganisms after intensive use of piperacillin/tazobactam . Hence, our findings in this controlled clinical trial are in clear contrast with reports of prophylaxis in patients undergoing urological procedures and in females with recurrent UTI in whom FOS has been proven superior …”

Role of intestinal dysbiosis on gut colonization by bacterial pathogens

“…Various studies have identified different antibiotic treatments, among which are aminoglycosides, carbapenems, quinolones and colistin, as risk factors for the presence of antibiotic-resistant Enterobacteriaceae in the gut (76,78,86,152). These studies, as the ones obtained in our mouse experiments, suggest that disruption of the CR by antibiotic treatment opens the way to colonization with MRE.…”

KlebSeq: A Diagnostic Tool for Healthcare Surveillance and Antimicrobial Resistance Monitoring ofKlebsiella pneumoniae

“…If screening of large numbers of patients by amplicon sequencing is cost-prohibitive, it can be limited to the highest-risk groups of patients, i.e . long-term care facility patients (31, 65), travelers returning from endemic regions (66, 67), ICU patients (28), patients that previously carried (67-69), patients that shared a room with a known carrier (70) or case contacts of carriers (71), those who’ve recently taken antibiotics (72, 73), or patients on mechanical ventilation, enteral feeds, or that have had prior Clostridium difficile infections (74). Additionally, using ASAP makes the analysis in KlebSeq streamlined, and results are easily interpretable.…”