Risk factors for acquisition of carbapenem resistant Enterobacteriaceae in an acute tertiary care hospital in Singapore

Ling, Moi Lin; Tee, Yong Ming; Tan, Soong; Amin, I.M.; How, Kue Bien; Tan, Kwee Yuen; Lee, Lai Chee

doi:10.1186/s13756-015-0066-3

Cited by 80 publications

(80 citation statements)

References 23 publications

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“…3,4,9,10,[26][27][28] These discrepancies might be related at least in part to different definitions of antimicrobial exposure and the possibility of uncontrolled confounders in retrospective studies. 29 In our study, the small number of patients who received each specific class of antibiotic limited our ability to find statistically significant associations.…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Acquisition Among Contacts of Newly Diagnosed CP-CRE Patients

Schwartz-Neiderman

Braun

Fallach

et al. 2016

Infect. Control Hosp. Epidemiol.

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objective. Carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) are extremely drug-resistant pathogens. Screening of contacts of newly identified CP-CRE patients is an important step to limit further transmission. We aimed to determine the risk factors for CP-CRE acquisition among patients exposed to a CP-CRE index patient.methods. A matched case-control study was performed in a tertiary care hospital in Israel. The study population was comprised of patients who underwent rectal screening for CP-CRE following close contact with a newly identified CP-CRE index patient. Cases were defined as positive tests for CP-CRE. For each case patient, 2 matched controls were randomly selected from the pool of contacts who tested negative for CP-CRE following exposure to the same index case. Bivariate and multivariate analyses were conducted using conditional logistic regression.results. In total, 53 positive contacts were identified in 40 unique investigations (896 tests performed on 735 contacts) between October 6, 2008, and June 7, 2012. bla KPC was the only carbapenemase identified. In multivariate analysis, risk factors for CP-CRE acquisition among contacts were (1) contact with an index patient for ≥3 days (odds ratio [OR], 9.8; 95% confidence interval [CI], 2.0-48.9), (2) mechanical ventilation (OR, 4.1; 95% CI, 1.4-11.9), and (3) carriage or infection with another multidrug-resistant organism (MDRO; OR, 2.6; 95% CI, 1.0-7.1). Among patients who received antibiotics, cephalosporins were associated with a lower risk of acquisition.conclusions. Patient characteristics (ventilation and carriage of another MDRO) as well as duration of contact are risk factors for CP-CRE acquisition among contacts. The role of cephalosporins requires further study.

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Section: Discussionmentioning

confidence: 99%

“…23,26,27 However, acquisition events may be influenced by the characteristics of the carrier who is the transmitter. We showed in a previous study that 20% of the carriers are responsible for 80% of the environmental spread.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Acquisition Among Contacts of Newly Diagnosed CP-CRE Patients

Schwartz-Neiderman

Braun

Fallach

et al. 2016

Infect. Control Hosp. Epidemiol.

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“…However, few studies have specifically assessed the risk factors and clinical outcomes for carbapenem-resistant ESBL-producing Enterobacteriaceae (ESBL-CRE) infection 11. Moreover, most studies have used the traditional case–control design to identify the risk factors for CRE infection, overestimating the effect of antibiotics by comparing resistant and susceptible isolates 12,13. The aim of our study was to identify some specific risk factors associated with ESBL-CRE infection by using a case–case–control study.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of and risk factors for infection with extended-spectrum β-lactamase-producing carbapenem-resistant Enterobacteriaceae: results of a double case–control study

Tian¹,

Sun²,

Jia³

et al. 2018

IDR

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PurposeCarbapenem-resistant Enterobacteriaceae (CRE) have been increasingly reported worldwide and pose a serious public threat, but the clinical significance of extended-spectrum β-lactamase (ESBL) production in CRE is not well established.Patients and methodsA retrospective case–case–control study was conducted to identify the clinical characteristics of patients with ESBL-CRE. The susceptibility of isolates obtained from these patients was assessed. The detection of ESBL and carbapenemase-related genes was performed by PCR methods. Predictors of 30-day mortality in patients with ESBL-CRE infection were also identified in our study.ResultsA total of 149 patients with CRE infection caused by Enterobacter cloacae (n=74), Escherichia coli (n=38), and Klebsiella pneumoniae (n=37) were identified in Chongqing, Southwestern China, between January 2011 and December 2014. Of the 35 isolates detected with carbapenemase-related genes, 16 isolates had New Delhi metallo-β-lactamase (NDM), nine isolates had K. pneumoniae carbapenemase (KPC), seven isolates had imipenemase (IMP), and four isolates had oxacillinase (OXA)-1. One strain of enterobacter cloacae carried both NDM-1 and IMP-8 genes. ESBL isolates included the genes CTX-M (72/149), SHV (64/149), and TEM (54/149). All ESBL-CRE isolates exhibited ertapenem resistance, and the rate of cephalosporin resistance was relatively high in general. Independent risk factors for infection with ESBL-CRE included previous exposure to β-lactam antibiotics, transfer from another hospital, and some underlying diseases. In addition, solid tumors, hypoalbuminemia, and central venous catheters were independent predictors of mortality in patients with ESBL-CRE infection.ConclusionPhysicians should understand the peculiar predictors for the identification of these organisms among high-risk patients.

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“…28 Other reports confirm that previous hospitalizations and previous ICU admission are the stronger predictors of CRKP acquisition. 29 The rate of enteric CRKP colonization in ICUs is actually very high (>70%), in particular among patients with prolonged hospitalization. 30,31 Duration of enteric colonization after discharge has been evaluated in patients recently (<4 months) or remotely (≥4 months) colonized.…”

Section: Risk Factors For Carbapenem-resistant Klebsiella Pneumoniae mentioning

confidence: 99%

Risk factors and outcomes of carbapenem-resistant Klebsiella pneumoniae infections

Pistella

Santini

2016

Ital J Med

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In the nosocomial setting, antimicrobial-resistant Enterobacteriaceae are a growing challenge, and alarming trends in resistance are currently reported all over the world. Isolates of Enterobacteriaceae producing ampC β-lactamases and extended spectrum β-lactamases are endemic in many hospitals, and are frequently resistant also to other classes of antibiotics, such as fluoroquinolones and aminoglycosides. The risk of infections due to multi-drug resistant strains should be considered also for outpatients who have had recent contact with the health system. Both nosocomial and health-care associated infections should be treated with a combination of antibiotics active against multi-drug resistant Gram negative and methicillin-resistant Staphylococcus aureus. In the absence of effective antimicrobial stewardship programs, this aggressive therapeutic approach might lead to abuse of broad-spectrum antibiotics, with consequent increase in resistances. To contain the possible antibiotic overuse, several decisional strategies, often based on risk-score systems supporting the clinical decisions, have been proposed. In this context of high antibiotic selection pressure, carbapenem-resistant pathogens recently began to spread in many hospitals. Carbapenem-resistant Klebsiella pneumoniae, as well as carbapenem-resistant Acinetobacter baumannii and P. aeruginosa, represent the new major challenges to patient safety. Against these organisms the initial empiric treatment is generally ineffective. The poor clinical outcome associated with carbapenem- resistant K. pneumoniae infections is probably due to the delete in the beginning of an appropriate antibiotic treatment, rather than to the increased virulence of pathogens. Only few therapeutic options are available, including colistin, tigecycline, aminoglycosides and carbapenems in selected cases. Several combinations of these antibiotics have been used, but no ideal regimen has been currently established.

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Risk factors for acquisition of carbapenem resistant Enterobacteriaceae in an acute tertiary care hospital in Singapore

Cited by 80 publications

References 23 publications

Risk Factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Acquisition Among Contacts of Newly Diagnosed CP-CRE Patients

Risk Factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Acquisition Among Contacts of Newly Diagnosed CP-CRE Patients

Epidemiology of and risk factors for infection with extended-spectrum β-lactamase-producing carbapenem-resistant Enterobacteriaceae: results of a double case–control study

Risk factors and outcomes of carbapenem-resistant Klebsiella pneumoniae infections

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Risk factors for acquisition of carbapenem resistant Enterobacteriaceae in an acute tertiary care hospital in Singapore

Cited by 80 publications

References 23 publications

Risk Factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Acquisition Among Contacts of Newly Diagnosed CP-CRE Patients

Risk Factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Acquisition Among Contacts of Newly Diagnosed CP-CRE Patients

Epidemiology of and risk factors for infection with extended-spectrum &beta;-lactamase-producing carbapenem-resistant Enterobacteriaceae: results of a double case&ndash;control study

Risk factors and outcomes of carbapenem-resistant Klebsiella pneumoniae infections

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Epidemiology of and risk factors for infection with extended-spectrum β-lactamase-producing carbapenem-resistant Enterobacteriaceae: results of a double case–control study