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

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

Retrospective cohort study.

University-affiliated general hospital.

A cohort of 168 CRE carriers with 474 readmissions.

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.

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.

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

The use of antidepressant drugs in patients with ischaemic heart disease (IHD) has been debated owing to scarcity of data and conflicting results regarding the effect of these drugs on mortality.

To evaluate the association between adherence to antidepressant therapy and all-cause mortality in a population-based cohort of patients with IHD.

A total of 63 437 patients with IHD who purchased antidepressants at least once during the years 2008–2011 were retrospectively followed for all-cause mortality over 4 years. Adherence was measured as a ratio between claimed and prescribed durations of medication and modelled as non-adherence (<20%), poor (20–50%), moderate (50–80%) and good (>80%). We used multivariable survival analyses adjusted for demographic and clinical variables that may affect mortality.

The moderate and good adherence groups had significantly reduced adjusted mortality hazard ratios of 0.83 (95% CI 0.78–0.88) and 0.86 (95% CI 0.82–0.90) respectively, compared with the non-adherence group.

Adherence to antidepressant pharmacotherapy is associated with reduced all-cause mortality in a population-based large sample cohort of patients with IHD. Physicians and health policy decision-makers should step up their efforts to sustain and enhance these patients' adherence to their antidepressant regimen.