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

Published online by Cambridge University Press:  23 June 2020

Amal Kassem ,
Aman Raed ,
Tal Michael ,
Orli Sagi ,
Orly Shimoni ,
Abraham Borer  and
Lisa Saidel-Odes Open the ORCID record for Lisa Saidel-Odes [Opens in a new window]
Amal Kassem
Affiliation:
The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Aman Raed
Affiliation:
The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Tal Michael
Affiliation:
Department of Public Health, the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Orli Sagi
Affiliation:
Clinical Microbiology Laboratory, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Orly Shimoni
Affiliation:
Hospital Pharmacy, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Abraham Borer
Affiliation:
Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Lisa Saidel-Odes*
Affiliation:
Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
*
Author for correspondence: Lisa Saidel-Odes, E-mail: lisasod@clalit.org.il
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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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 10 , October 2020 , pp. 1154 - 1161
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

a

Authors of equal contribution.

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