Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-24T22:58:13.812Z Has data issue: false hasContentIssue false
  • English
  • Français

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])
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Patel, G, Huprikar, S, Factor, SH, Jenkins, SG, Calfee, DP. Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol 2008;29:1099–1106.CrossRefGoogle ScholarPubMed
2.Schwaber, MJ, Klarfeld-Lidji, S, Navon-Venezia, S, Schwartz, D, Leavitt, A, Carmeli, Y. Predictors of carbapenem-resistant Klebsiella pneumoniae acquisition among hospitalized adults and effect of acquisition on mortality. Antimicrob Agents Chemother 2008;52:1028–1033.Google Scholar
3.Calfee, D, Jenkins, SG. Use of active surveillance cultures to detect asymptomatic colonization with carbapenem-resistant Klebsiella pneumoniae in intensive care unit patients. Infect Control Hosp Epidemiol 2008;29:966–968.Google Scholar
4.Bratu, S, Landman, D, Haag, R, et al.Rapid spread of carbapenem-resistant Klebsiella pneumoniae in New York City: a new threat to our antibiotic armamentarium. Arch Intern Med 2005;165: 1430–1435.Google Scholar
5.Ben-David, D, Maor, Y, Keller, N, et al.Potential role of active surveillance in the control of a hospital-wide outbreak of carbapenem-resistant Klebsiella pneumoniae infection. Infect Control Hosp Epidemiol 2010;31:620–626.CrossRefGoogle ScholarPubMed
6.Ben-David, D, Masarwa, S, Navon-Venezia, S, et al.Carbapenem-resistant Klebsiella pneumoniae in post-acute-care facilities in Israel. Infect Control Hosp Epidemiol 2011;32:845–853.Google Scholar
7.Chitnis, AS, Caruthers, PS, Rao, AK, et al.Outbreak of carbapenem-resistant Enterobacteriaceae at a long-term acute care hospital: sustained reductions in transmission through active surveillance and targeted interventions. Infect Control Hosp Epidemiol 2012;33:984–992.Google Scholar
8.Schwaber, M, Lev, B, Israeli, A, et al.Containment of a countrywide outbreak of carbapenem-resistant Klebsiella pneumoniae in Israeli hospitals via a nationally implemented intervention. Clin Infect Dis 2011;52:1–8.CrossRefGoogle Scholar
9.Marchaim, D, Chopra, T, Bhargava, A, et al.Recent exposure to antimicrobials and carbapenem-resistant Enterobacteriaceae: the role of antimicrobial stewardship. Infect Control Hosp Epidemiol 2012;33:817–830.Google Scholar
10.Gasink, LB, Edelstein, PH, Lautenbach, E, Synnestvedt, M, Fish-man, NO. Risk factors and clinical impact of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae. Infect Control Hosp Epidemiol 2009;30:1180–1185.CrossRefGoogle ScholarPubMed
11.Landman, D, Babu, E, Shah, N, et al.Transmission of carbapenem-resistant pathogens in New York City hospitals: progress and frustration. J Antimicrob Chemother 2012;67:1427–1431.Google Scholar
12.Landman, D, Salvani, JK, Bratu, S, Quale, J. Evaluation of techniques for detection of carbapenem-resistant Klebsiella pneumoniae in stool surveillance cultures. J Clin Microbiol 2005;43:5639–5641.Google Scholar
13.Kitchel, B, Lonsway, D, Wong, B, Rasheed, J. Detection of the bla KPC gene encoding Klebsiella pneumoniae carbapenemase (KPC) by real-time PCR. In: Clinical Microbiology Procedures Handbook. 3rd ed. Washington, DC: ASM, 2010:2041–2050.Google Scholar
14.Polk, RE, Fox, C, Mahoney, A, Letcavage, J, MacDougall, C. Measurement of adult antibacterial drug use in 130 US hospitals: comparison of defined daily dose and days of therapy. Clin Infect Dis 2007;44:664–670.CrossRefGoogle ScholarPubMed
15.Kitchel, B, Rasheed, JK, Patel, JB, et al.Molecular epidemiology of KPC-producing Klebsiella pneumoniae isolates in the United States: clonal expansion of multilocus sequence type 258. Antimicrob Agents Chemother 2009;53:3365–3370.CrossRefGoogle ScholarPubMed
16.Merrer, J, Santoli, F, Appéré de Vecchi, C, Tran, B, De Jonghe, B, Outin, H. “Colonization pressure” and risk of acquisition of methicillin-resistant Staphylococcus aureus in a medical intensive care unit. Infect Control Hosp Epidemiol 2000;21:718–723.CrossRefGoogle Scholar
17.Bonten, MJ, Slaughter, S, Ambergen, AW, et al.The role of “colonization pressure” in the spread of vancomycin-resistant en-terococci: an important infection control variable. Arch Intern Med 1998;158:1127–1132.Google Scholar
18.Lawrence, SJ, Puzniak, LA, Shadel, BN, Gillespie, KN, Kollef, MH, Mundy, LM. Clostridium difficile in the intensive care unit: epidemiology, costs, and colonization pressure. Infect Control Hosp Epidemiol 2007;28:123–130.Google Scholar
19.Centers for Disease Control and Prevention. Guidance for control of carbapenem-resistant Enterobacteriaceae (CRE). 2012 CRE Toolkit. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion, 2012. http://www.cdc.gov/hai/pdfs/cre/CRE-guidance-508.pdf. Accessed February 22, 2013.Google Scholar
20.Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L; Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in healthcare settings, 2006. Centers for Disease Control and Prevention, 2006. http://www.cdc.gov/ncidod/dhqp/pdf/ar/MDROGuideline2006.pdf. Accessed February 22, 2013.Google Scholar
21.Munoz-Price, LS, De La Cuesta, C, Adams, S, et al.Successful eradication of a monoclonal strain of Klebsiella pneumoniae during a K. pneumoniae carbapenemase-producing K. pneumoniae outbreak in a surgical intensive care unit in Miami, Florida. Infect Control Hosp Epidemiol 2010;31:1074–1077.CrossRefGoogle Scholar
22.Nseir, S, Blazejewski, C, Lubret, R, Wallet, F, Courcol, R, Durocher, A. Risk of acquiring multidrug-resistant gram-negative bacilli from prior room occupants in the intensive care unit. Clin Microbiol Infect 2011;17:1201–1208.CrossRefGoogle ScholarPubMed
23.Snitkin, ES, Zelazny, AM, Thomas, PJ, et al.Tracking a hospital outbreak of carbapenem-resistant Klebsiella pneumoniae with whole-genome sequencing. Sci Transi Med 2012;4:148ra116.Google ScholarPubMed
24.Hecker, MT, Aron, DC, Patel, NP, Lehmann, MK, Donskey, CJ. Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Arch Intern Med 2003;163:972–978.CrossRefGoogle ScholarPubMed
25.Shaughnessy, MK, Amundson, WH, Kuskowski, MA, DeCarolis, DD, Johnson, JR, Drekonja, DM. Unnecessary antimicrobial use in patients with current or recent Clostridium difficile infection. Infect Control Hosp Epidemiol 2013;34:109–116.Google Scholar
26.Weintrob, AC, Roediger, MP, Barber, M, et al.Natural history of colonization with gram-negative multidrug-resistant organisms among hospitalized patients. Infect Control Hosp Epidemiol 2010; 31:330–337.CrossRefGoogle ScholarPubMed
27.Wiener-Well, Y, Rudensky, B, Yinnon, AM, et al.Carriage rate of carbapenem-resistant Klebsiella pneumoniae in hospitalised patients during a national outbreak. J Hosp Infect 2010;74:344–349.CrossRefGoogle ScholarPubMed