Hostname: page-component-848d4c4894-ttngx Total loading time: 0 Render date: 2024-05-15T16:19:23.927Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk Factors for Recurrence of Carbapenem-Resistant Enterobacteriaceae Carriage: Case-Control Study

Published online by Cambridge University Press:  14 April 2015

Yossi Bart ,
Mical Paul ,
Orna Eluk ,
Yuval Geffen ,
Galit Rabino  and
Khetam Hussein
Yossi Bart
Affiliation:
Rappaport Faculty of Medicine and Research Institute, Technion–Israel Institute of Technology, Haifa, Israel
Mical Paul
Affiliation:
Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
Orna Eluk
Affiliation:
Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
Yuval Geffen
Affiliation:
Rappaport Faculty of Medicine and Research Institute, Technion–Israel Institute of Technology, Haifa, Israel Clinical Microbiology Laboratory, Rambam Health Care Campus, Haifa, Israel
Galit Rabino
Affiliation:
Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
Khetam Hussein*
Affiliation:
Rappaport Faculty of Medicine and Research Institute, Technion–Israel Institute of Technology, Haifa, Israel Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
*
Address correspondence to Khetam Hussein, MD, Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel (k_hussein@rambam.health.gov.il).
Get access Rights & Permissions [Opens in a new window]

Abstract

BACKGROUND

The natural history of carbapenem-resistant Enterobacteriaceae (CRE) carriage and the timing and procedures required to safely presume a CRE-free status are unclear.

OBJECTIVE

To determine risk factors for recurrence of CRE among presumed CRE-free patients.

METHODS

Case-control study including CRE carriers in whom CRE carriage presumably ended, following at least 2 negative screening samples on separate days. Recurrence of CRE carriage was identified through clinical samples and repeated rectal screening in subsequent admissions to any healthcare facility in Israel. Patients with CRE recurrence (cases) were compared with recurrence-free patients (controls). The duration of follow-up was 1 year for all surviving patients.

RESULTS

Included were 276 prior CRE carriers who were declared CRE-free. Thirty-six persons (13%) experienced recurrence of CRE carriage within a year after presumed eradication. Factors significantly associated with CRE recurrence on multivariable analysis were the time in months between the last positive CRE sample and presumed eradication (odds ratio, 0.94 [95% CI, 0.89–0.99] per month), presence of foreign bodies at the time of presumed eradication (4.6 [1.64–12.85]), and recurrent admissions to healthcare facilities during follow-up (3.15 [1.05–9.47]). The rate of CRE recurrence was 25% (11/44) when the carrier status was presumed to be eradicated 6 months after the last known CRE-positive sample, compared with 7.5% (10/134) if presumed to be eradicated after 1 year.

CONCLUSIONS

We suggest that the CRE-carrier status be maintained for at least 1 year following the last positive sample. Screening of all prior CRE carriers regardless of current carriage status is advised.

Infect. Control Hosp. Epidemiol. 2015;36(8):936–941

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 8 , August 2015 , pp. 936 - 941
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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

REFERENCES

1. 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
2. Souli, M, Galani, I, Antoniadou, A, et al. An outbreak of infection due to beta-lactamase Klebsiella pneumoniae carbapenemase 2-producing K. pneumoniae in a Greek university hospital: molecular characterization, epidemiology, and outcomes. Clin Infect Dis 2010;50:364–373.CrossRefGoogle Scholar
3. Glasner, C, Albiger, B, Buist, G, et al. Carbapenemase-producing Enterobacteriaceae in Europe: a survey among national experts from 39 countries, February 2013. Eurosurveillance 2013;18:9–15.Google Scholar
4. Gupta, N, Limbago, BM, Patel, JB, Kallen, AJ. Carbapenem-resistant Enterobacteriaceae: epidemiology and prevention. Clin Infect Dis 2011;53:60–67.CrossRefGoogle ScholarPubMed
5. Hussein, K, Sprecher, H, Mashiach, T, Oren, I, Kassis, I, Finkelstein, R. Carbapenem resistance among Klebsiella pneumoniae isolates: risk factors, molecular characteristics, and susceptibility patterns. Infect Control Hosp Epidemiol 2009;30:666–671.Google Scholar
6. Samra, Z, Ofir, O, Lishtzinsky, Y, Madar-Shapiro, L, Bishara, J. Outbreak of carbapenem-resistant Klebsiella pneumoniae producing KPC-3 in a tertiary medical centre in Israel. Int J Antimicrob Agents 2007;30:525–529.CrossRefGoogle Scholar
7. Leavitt, A, Navon-Venezia, S, Chmelnitsky, I, Schwaber, MJ, Carmeli, Y. Emergence of KPC-2 and KPC-3 in carbapenem-resistant Klebsiella pneumoniae strains in an Israeli hospital. Antimicrob Agents Chemother 2007;51:3026–3029.CrossRefGoogle Scholar
8. 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
9. Schwaber, MJ, Lev, B, Israeli, A, et al. Containment of a country-wide outbreak of carbapenem-resistant Klebsiella pneumoniae in Israeli hospitals via a nationally implemented intervention. Clin Infect Dis 2011;52:848–855.Google Scholar
10. Zimmerman, FS, Assous, MV, Bdolah-Abram, T, Lachish, T, Yinnon, AM, Wiener-Well, Y. Duration of carriage of carbapenem-resistant Enterobacteriaceae following hospital discharge. Am J Infect Control 2013;41:190–194.Google Scholar
11. Schechner, V, Kotlovsky, T, Tarabeia, J, et al. Predictors of rectal carriage of carbapenem-resistant Enterobacteriaceae (CRE) among patients with known CRE carriage at their next hospital encounter. Infect Control Hosp Epidemiol 2011;32:497–503.CrossRefGoogle ScholarPubMed
12. Ahn, JY, Song, JE, Kim, MH, et al. Risk factors for the acquisition of carbapenem-resistant Escherichia coli at a tertiary care center in South Korea: a matched case-control study. Am J Infect Control 2014;42:621–625.Google Scholar
13. Falagas, ME, Rafailidis, PI, Kofteridis, D, et al. Risk factors of carbapenem-resistant Klebsiella pneumoniae infections: a matched case-control study. J Antimicrob Chemother 2007;60:1124–1130.Google Scholar
14. Falagas, ME, Kopterides, P. Risk factors for the isolation of multi-drug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa: a systematic review of the literature. J Hosp Infect 2006;64:7–15.CrossRefGoogle ScholarPubMed