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Risk-factor analysis for extended-spectrum beta-lactamase–producing Enterobacterales colonization or infection: Evaluation of a novel approach to assess local prevalence as a risk factor

Published online by Cambridge University Press:  28 April 2023

Jerald P. Cherian Open the ORCID record for Jerald P. Cherian [Opens in a new window] ,
Sara E. Cosgrove ,
Fardad Haghpanah ,
Eili Y. Klein Open the ORCID record for Eili Y. Klein [Opens in a new window]  and
for the Centers for Disease Control and Prevention’s Prevention Epicenters Program and the Modeling Infectious Diseases in Healthcare Network
Jerald P. Cherian*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
Sara E. Cosgrove
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
Fardad Haghpanah
Affiliation:
One Health Trust, Silver Spring, Maryland, United States of America
Eili Y. Klein
Affiliation:
One Health Trust, Silver Spring, Maryland, United States of America Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
*
Author for correspondence: Jerald P. Cherian, E-mail: [email protected]
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Abstract

Objective:

To explore an approach to identify the risk of local prevalence of extended-spectrum β-lactamase–producing Enterobacterales (ESBL-E) on ESBL-E colonization or infection and to reassess known risk factors.

Design:

Case–control study.

Setting:

Johns Hopkins Health System emergency departments (EDs) in the Baltimore–Washington, DC, region.

Patients:

Patients aged ≥18 years with a culture growing Enterobacterales between April 2019 and December 2021. Cases had a culture growing an ESBL-E.

Methods:

Addresses were linked to Census Block Groups and placed into communities using a clustering algorithm. Prevalence in each community was estimated using the proportion of ESBL-E among Enterobacterales isolates. Logistic regression was used to determine risk factors for ESBL-E colonization or infection.

Results:

ESBL-E were detected in 1,167 of 11,224 patients (10.4%). Risk factors included a history of ESBL-E in the prior 6 months (aOR, 20.67; 95% CI, 13.71–31.18), exposure to a skilled nursing or long-term care facility (aOR, 1.64; 95% CI, 1.37–1.96), exposure to a third-generation cephalosporin (aOR, 1.79; 95% CI, 1.46–2.19), exposure to a carbapenem (aOR, 2.31; 95% CI, 1.68–3.18), or exposure to a trimethoprim-sulfamethoxazole (aOR, 1.54; 95% CI, 1.06–2.25) within the prior 6 months. Patients were at lower risk if their community had a prevalence <25th percentile in the prior 3 months (aOR, 0.83; 95% CI, 0.71–0.98), 6 months (aOR, 0.83; 95% CI, 0.71–0.98), or 12 months (aOR, 0.81; 95% CI, 0.68–0.95). There was no association between being in a community in the >75th percentile and the outcome.

Conclusions:

This method of defining the local prevalence of ESBL-E may partially capture differences in the likelihood of a patient having an ESBL-E.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 11 , November 2023 , pp. 1793 - 1800
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Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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