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Predictors of Persistent Carbapenem-Resistant Enterobacteriaceae Carriage upon Readmission and Score Development

Published online by Cambridge University Press:  11 January 2016

Pnina Ciobotaro ,
Natalie Flaks-Manov ,
Maly Oved ,
Ami Schattner ,
Moshe Hoshen ,
Eli Ben-Yosef ,
Ran D. Balicer  and
Oren Zimhony
Pnina Ciobotaro*
Affiliation:
Infectious Diseases Unit, Kaplan Medical Center, Rehovot, Israel Hebrew University Hadassah Medical School, Jerusalem, Israel Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel-Aviv, Israel
Natalie Flaks-Manov
Affiliation:
Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel-Aviv, Israel
Maly Oved
Affiliation:
Infectious Diseases Unit, Kaplan Medical Center, Rehovot, Israel Hebrew University Hadassah Medical School, Jerusalem, Israel
Ami Schattner
Affiliation:
Hebrew University Hadassah Medical School, Jerusalem, Israel Department of Medicine, Kaplan Medical Center, Rehovot, Israel
Moshe Hoshen
Affiliation:
Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel-Aviv, Israel
Eli Ben-Yosef
Affiliation:
Hebrew University Hadassah Medical School, Jerusalem, Israel Computer Department, Kaplan Medical Center, Rehovot, Israel
Ran D. Balicer
Affiliation:
Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel-Aviv, Israel Epidemiology Department, Ben-Gurion University, Beer-Sheva, Israel
Oren Zimhony*
Affiliation:
Infectious Diseases Unit, Kaplan Medical Center, Rehovot, Israel Hebrew University Hadassah Medical School, Jerusalem, Israel
*
Address correspondence to Pnina Ciobotaro, MD, Infectious Diseases Unit, Kaplan Medical Center, P.O. Box 1, Rehovot, Israel (Pninaci@clalit.org.il) or Zimhony Oren, MD, Infectious Diseases Unit, Kaplan Medical Center, P.O.B. 1, Rehovot, Israel (oren_z@clalit.org.il).
Address correspondence to Pnina Ciobotaro, MD, Infectious Diseases Unit, Kaplan Medical Center, P.O. Box 1, Rehovot, Israel (Pninaci@clalit.org.il) or Zimhony Oren, MD, Infectious Diseases Unit, Kaplan Medical Center, P.O.B. 1, Rehovot, Israel (oren_z@clalit.org.il).
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Abstract

BACKGROUND

Carriers of carbapenem-resistant Enterobacteriaceae (CRE) are often readmitted, exposing patients to CRE cross-transmission.

OBJECTIVE

To identify predictors of persistent CRE carriage upon readmission, directing a risk prediction score.

DESIGN

Retrospective cohort study.

SETTING

University-affiliated general hospital.

PATIENTS

A cohort of 168 CRE carriers with 474 readmissions.

METHODS

The primary and secondary outcomes were CRE carriage status at readmission and length of CRE carriage. Predictors of persistent CRE carriage upon readmission were analyzed using a generalized estimating equations (GEE) multivariable model. Readmissions were randomly divided into derivation and validation sets. A CRE readmission score was derived to predict persistent CRE carriage in 3 risk groups: high, intermediate, and low. The discriminatory ability of the model and the score were expressed as C statistics.

RESULTS

CRE carrier status persisted for 1 year in 33% of CRE carriers. Positive CRE status was detected in 202 of 474 readmissions (42.6%). The following 4 variables were associated with persistent CRE carriage at readmission: readmission within 1 month (odds ratio [OR], 6.95; 95% confidence interval [CI], 2.79–17.30), positive CRE status on preceding admission (OR, 5.46; 95% CI, 3.06–9.75), low Norton score (OR, 3.07; 95% CI, 1.26–7.47), and diabetes mellitus (OR, 1.84; 95% CI, 0.98–3.44). The C statistics were 0.791 and 0.789 for the derivation set (n=322) model and score, respectively, and the C statistic was 0.861 for the validation set of the score (n=152). The rates of CRE carriage at readmissions (validation set) for the groups with low, intermediate, and high scores were 8.6%, 38.9%, and 77.6%, respectively.

CONCLUSIONS

CRE carrier state commonly persists upon readmission, and this risk can be estimated to guide screening policy and infection control measures.

Infect. Control Hosp. Epidemiol. 2016;37(2):188–196

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 2 , February 2016 , pp. 188 - 196
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

a

Authors with equal contribution.

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