Risk factors for carbapenem‐resistant Enterobacterales infection among hospitalized patients with previous colonization

Abstract

Background We aimed to identify the risk factors for subsequent carbapenem‐resistant Enterobacterales (CRE) infections in patients with initial rectal colonization with CRE. Methods We conducted a retrospective case–control study on inpatients with rectal CRE colonization between January 2019 and December 2020. Clinical and microbiological data were extracted from hospital patients' medical records and the clinical microbiology laboratory. Risk factors were assessed and compared between patients with CRE colonization who had subsequent infections and those who did not have infections. Results Among 1064 patients screened for CRE, we enrolled 205 patients with rectal CRE colonization. Among the 205 colonized bacteria, 78.5% were Klebsiella pneumoniae, with 62.9% of them producing Klebsiella pneumoniae carbapenemase (KPC). Multivariate logistic regression analysis revealed that more than three times hospitalization (p = 0.026), being in a coma (p = 0.019), and exposure to carbapenems (p = 0.015) were independent risk factors for CRE clinical infection among CRE rectal carriers. Conclusion This is the first study to report that more than three times hospitalization is an independent risk factor for subsequent CRE clinical infection in CRE intestinal carriers. Carbapenem‐resistant Klebsiella pneumoniae is the most important species isolated from hospitalized CRE rectal carriers and is the most common cause of subsequent infections.

Epidemiology and clinical characteristics of patients with carbapenem-resistant enterobacterales infections: experience from a large tertiary care center in a developing country

“…Understanding colonization as a critical step in infection progression provides a reason to detect colonized patients and potentially design intervention measures to avoid subsequent infection [ 19 ]. Approximately 40.6% of the CRE-infected patients in our study were colonized with CRE prior to developing infection compared to the 65% rate in the study by Xia Chen et al [ 20 ]. Moreover, some data suggest that active surveillance tests performed on admission may play a role in preventing the spread of resistant gram-negative organisms in healthcare institutions with regard to widespread cross-transmission and outbreaks [ 21 ].…”

Evaluation of the impact of COVID-19 pandemic on hospital admission related to common infections

“…30 Unlike these two studies and our study, others focused on risk prediction models for a specific infection, such as UTI, 31,32 sepsis, 33 or pneumonia, 34 and specific resistance strains, such as carbapenem-resistant Enterobacterales. 35,36 There are several strength and limitations of this study. The main strength of this study is that it only considered complications related to common infections in patients without COVID-19 that is conducted after the outbreak of COVID-19.…”

Emergence of KPC-113 and KPC-114 variants in ceftazidime-avibactam-resistant Klebsiella pneumoniae belonging to high-risk clones ST11 and ST16 in South America

“…Carbapenem-resistant K. pneumoniae has been the most important species recovered from surveillance rectal swabs of hospitalized patients and the most common cause of subsequent infections ( 25 , 26 ). In fact, colonization at multiple sites with carbapenem-resistant K. pneumoniae has been the strongest predictor of bloodstream infection development in previous large cohorts of carbapenem-resistant K. pneumoniae rectal carriers ( 27 ).…”