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Recent Exposure to Antimicrobials and Carbapenem-Resistant Enterobacteriaceae: The Role of Antimicrobial Stewardship

Published online by Cambridge University Press:  02 January 2015

Dror Marchaim*
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Teena Chopra
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Ashish Bhargava
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Christopher Bogan
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Sorabh Dhar
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Kayoko Hayakawa
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Jason M. Pogue
Affiliation:
Department of Pharmacy Services, Detroit Medical Center, Wayne State University, Detroit, Michigan
Suchitha Bheemreddy
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Christopher Blunden
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Maryann Shango
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Jessie Swan
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
Paul R. Lephart
Affiliation:
Department of Clinical Microbiology, Detroit Medical Center, Wayne State University, Detroit, Michigan
Federico Perez
Affiliation:
Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Department of Medicine, Case Western Reserve University, Cleveland, Ohio
Robert A. Bonomo
Affiliation:
Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Department of Medicine, Case Western Reserve University, Cleveland, Ohio Veterans Integrated Service Network 10 Geriatric Research, Education, and Clinical Centers at Veterans Affairs Medical Center, Cleveland, Ohio Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio Department of Molecular Biology and Microbiology, Case Western Reserve University, Cleveland, Ohio
Keith S. Kaye
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
*
Division of Infectious Diseases, 5 Hudson, Harper University Hospital, 3990 John R. Street, Detroit, MI 48201 (drormc@hotmail.com)

Abstract

Background.

Carbapenem-resistant Enterobacteriaceae (CRE) are rapidly emerging worldwide. Control group selection is critically important when analyzing predictors of antimicrobial resistance. Focusing on modifiable risk factors can optimize prevention and resource expenditures. To identify specific predictors of CRE, patients with CRE were compared with 3 control groups: (1) patients with extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, (2) patients with non-ESBL-containing Enterobacteriaceae, and (3) uninfected controls.

Design.

Matched multivariable analyses.

Patients and Setting.

Patients possessing CRE that were isolated at Detroit Medical Center from September 1, 2008, to August 31, 2009.

Methods.

Patients were matched (1:1 ratio) to the 3 sets of controls. Matching parameters included (1) bacteria type, (2) hospital/ facility, (3) unit/clinic, (4) calendar year, and (5) time at risk (ie, from admission to culture). Matched multivariable analyses were conducted between uninfected controls and patients with CRE, ESBL, and non-ESBL Enterobacteriaceae. Models were also designed comparing patients with CRE to patients with ESBL, patients with non-ESBL Enterobacteriaceae, and all 3 non-CRE groups combined.

Results.

Ninety-one unique patients with CRE were identified, and 6 matched models were constructed. Recent (less than 3 months) exposure to antibiotics was the only parameter that was consistently associated with CRE, regardless of the group to which CRE was compared, and was not independently associated with isolation of ESBL or non-ESBL Enterobacteriaceae.

Conclusions.

Exposure to antibiotics within 3 months was an independent predictor that characterized patients with CRE isolation. As a result, antimicrobial stewardship efforts need to become a major focus of preventive Interventions. Regulatory focus regarding appropriate antimicrobial use might decrease the detrimental effects of antibiotic misuse and spread of CRE.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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