Risk factors and outcomes of patients colonized with carbapenemase-producing and non–carbapenemase-producing carbapenem-resistant Enterobacteriaceae

Abstract

Objective: To compare risk factors and outcome of patients colonized with carbapenemase-producing (CP) carbapenem-resistant Enterobactereaceae (CRE) and non–CP-CRE. Design: A comparative historical study. Setting: A 1,000-bed tertiary-care university hospital. Patients: Adults with CP-CRE positive rectal swab cultures, non–CP-CRE positive rectal swab cultures, and negative rectal swab cultures (non-CRE). Methods: CP-CRE and non–CP-CRE colonized adult patients versus patients not colonized with CRE hospitalized during 24 months were included. We identified patients retrospectively through the microbiology laboratory, and we reviewed their files for demographics, underlying diseases, Charlson Index, treatment, and outcome. Results: This study included 447 patients for whom a rectal swab for CRE was obtained: 147 positive for CP-CRE, 147 positive for non–CP-CRE, and 147 negative for both. Patients with CP-CRE and non–CP-CRE versus no CRE more frequently resided in nursing homes (P<0.001), received antibiotics 3 months prior to admission (P < .001), and received glucocorticosteroids 3 months prior to admission (P = .047 and P < .001, respectively). Risk factors unique for non–CP-CRE versus CP-CRE colonization included mechanical ventilation and patient movement between hospital departments. Non–CP-CRE was a predictor for mechanical ventilation 2.5 that of CP-CRE colonization. In-hospital mortality was highest among non–CP-CRE–colonized patients. On COX multivariate regression for mortality prediction age, Charlson index and steroid treatment 3 months before admission influenced mortality (P = .027, P = .023, and P = .013, respectively). Conclusions: Overlapping and unique risk factors are associated with CP-CRE and non–CP-CRE colonization. Non–CP-CRE colonized patients had a higher in-hospital mortality rate.

Epidemiological Characteristics of Carbapenemase Producing Carbapenem-Resistant Enterobacteriaceae Colonization

“…The CCIS score of the CP-CRE group was higher than that of the non-CRE group in this study. In a study by Kassem et al [20] conducted in Israel, the CCIS score was significantly higher in the non-CP-CRE group than in the CP-CRE group, but multiple logistic regression analysis showed that CCIS was not related, which was consistent with the finding that it was not a risk factor for CP-CRE. CCIS is an index developed to predict the risk of death within one year of hospitalization based on the number of comorbidities and is often used to evaluate the prognosis or survival of patients [39].…”

“…CCIS is an index developed to predict the risk of death within one year of hospitalization based on the number of comorbidities and is often used to evaluate the prognosis or survival of patients [39]. Kassem et al [20] reported that as the CCIS score increased by 1 point, the in-hospital mortality rate increased by 1.09 times, indicating that CCIS reflects in-hospital mortality. The CCIS score has been reported to be related to increased mortality rates for the coronavirus disease in 2019 [40].…”

“…In a cohort study of US veterans, heart disease and gastroesophageal reflux disease [18] were identified as risk factors for CP-CRE. In contrast, in a study that divided patients with CRE into CP-CRE and non-CP-CRE groups at an Israeli tertiary hospital, prehospital antibiotic use, experience in nursing homes, and the presence or absence of pressure sores were identified as risk factors for CP-CRE; age was not a risk factor [20]. The use of mechanical ventilation was a protective factor for CP-CRE when the CP-CRE and non-CP-CRE groups were compared, whereas the use of mechanical ventilation appeared as a risk factor when compared with the non-CRE group [20].…”

“…In contrast, in a study that divided patients with CRE into CP-CRE and non-CP-CRE groups at an Israeli tertiary hospital, prehospital antibiotic use, experience in nursing homes, and the presence or absence of pressure sores were identified as risk factors for CP-CRE; age was not a risk factor [20]. The use of mechanical ventilation was a protective factor for CP-CRE when the CP-CRE and non-CP-CRE groups were compared, whereas the use of mechanical ventilation appeared as a risk factor when compared with the non-CRE group [20]. In another study with CRE colonized group, the mechanical ventilation was identified as a risk factor for CP-CRE because the use of mechanical ventilation [21] in the CP-CRE group was higher than that of the non-CP-CRE group.…”

“…However, careful interpretation of the results is required because of the following limitations. First, since this study is a secondary data analysis study using existing data, variables identified as CP-CRE-related factors in previous studies [20] but were not included in the primary data sources (for example, pressure ulcers and use of antibiotics prior to admission) were excluded from the explanatory variables. Second, data were collected from the date of hospitalization until the date of CRE colonization for the CRE colonized group (CP-CRE group, non-CP-CRE group) and until the date of discharge from the ICU for the non-CRE group, where differences in data collection time can influence the length of stay in the ICU.…”