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Prevalence and Risk Factors for Acquisition of Carbapenem-Resistant Enterobacteriaceae in the Setting of Endemicity

Published online by Cambridge University Press:  02 January 2015

Mahesh Swaminathan ,
Saarika Sharma ,
Stephanie Poliansky Blash ,
Gopi Patel ,
David B. Banach ,
Michael Phillips ,
Vincent LaBombardi ,
Karen F. Anderson ,
Brandon Kitchel  and
Arjun Srinivasan
...Show all authors
Mahesh Swaminathan
Affiliation:
Department of Medicine, Mount Sinai School of Medicine, New York, New York
Saarika Sharma
Affiliation:
Department of Medicine, New York University Langone Medical Center, New York, New York
Stephanie Poliansky Blash
Affiliation:
Department of Medicine, Mount Sinai School of Medicine, New York, New York
Gopi Patel
Affiliation:
Department of Medicine, Mount Sinai School of Medicine, New York, New York
David B. Banach
Affiliation:
Department of Medicine, Mount Sinai School of Medicine, New York, New York
Michael Phillips
Affiliation:
Department of Medicine, New York University Langone Medical Center, New York, New York
Vincent LaBombardi
Affiliation:
Department of Pathology, Mount Sinai School of Medicine, New York, New York
Karen F. Anderson
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Brandon Kitchel
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Arjun Srinivasan
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
David P. Calfee*
Affiliation:
Department of Medicine, Mount Sinai School of Medicine, New York, New York Department of Medicine, Weill Cornell Medical College, New York, New York
*
Associate Professor of Medicine and Public Health, Weill Cornell Medical College, 525 East 68th Street, Box 265, New York, NY 10065 ([email protected])
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Abstract

Objective.

To describe the epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) carriage and acquisition among hospitalized patients in an area of CRE endemicity.

Design.

Cohort study with a nested case-control study.

Setting.

Two acute care, academic hospitals in New York City.

Participants.

All patients admitted to 7 study units, including intensive care, medical-surgical, and acute rehabilitation units.

Method.

Perianal samples were collected from patients at admission and weekly thereafter to detect asymptomatic gastrointestinal carriage of CRE. A nested case-control study was performed to identify factors associated with CRE acquisition. Case patients were those who acquired CRE during a single hospitalization. Control subjects had no microbiologic evidence of CRE and at least 1 negative surveillance sample. Clinical data were abstracted from the medical record.

Results.

The prevalence of CRE in the study population was 5.4% (306 of 5,676 patients), and 104 patients met the case definition of acquisition during a single hospital stay. Mechanical ventilation (odds ratio [OR], 11.5), pulmonary disease (OR, 5.2), days of antibiotic therapy (OR, 1.04), and CRE colonization pressure (OR, 1.15) were independently associated with CRE acquisition. Pulsed-field gel electrophoresis analysis identified 87% of tested Klebsiella pneumoniae isolates as sharing related patterns (greater than 78% similarity), which suggests clonal transmission within and between the study hospitals.

Conclusions.

Critical illness and underlying medical conditions, CRE colonization pressure, and antimicrobial exposure are important risk factors for CRE acquisition. Adherence to infection control practices and antimicrobial stewardship appear to be critical components of a CRE control program.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 8 , August 2013 , pp. 809 - 817
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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