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Risk Factors for Colonization due to Carbapenem-Resistant Enterobacteriaceae among Patients: Exposed to Long-Term Acute Care and Acute Care Facilities

Published online by Cambridge University Press:  10 May 2016

Ashish Bhargava*
Affiliation:
Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan
Kayoko Hayakawa
Affiliation:
Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan
Ethan Silverman
Affiliation:
Wayne State School of Medicine, Detroit, Michigan
Samran Haider
Affiliation:
Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan
Krishna Chaitanya Alluri
Affiliation:
Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan
Satya Datla
Affiliation:
Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan
Sreelatha Diviti
Affiliation:
Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan
Vamsi Kuchipudi
Affiliation:
Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan
Kalyan Srinivas Muppavarapu
Affiliation:
Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan
Paul R. Lephart
Affiliation:
Detroit Medical Center, Detroit, Michigan
Dror Marchaim
Affiliation:
Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan
Keith S. Kaye
Affiliation:
Division of Infectious Diseases, Wayne State University, Detroit Medical Center, Detroit, Michigan
*Corresponding
5 Hudson Harper, 540 East Canfield, Detroit Medical Center, Room 5911, Detroit, MI 48201 (drashishbhargava@gmail.com)

Abstract

Background.

This study aimed to identify risk factors associated with carbapenem-resistant Enterobacteriaceae (CRE) colonization among patients screened with rectal cultures upon admission to a hospital or long-term acute care (LTAC) center and to compare risk factors among patients who were screen positive for CRE at the time of hospital admission with those screen positive prior to LTAC admission.

Methods.

A retrospective nested matched case-control study was conducted from June 2009 to December 2011. Patients with recent LTAC exposure were screened for CRE carriage at the time of hospital admission, and patients admitted to a regional LTAC facility were screened prior to LTAC admission. Cases were patients with a positive CRE screening culture, and controls (matched in a 3:1 ratio to cases) were patients with negative screening cultures.

Results.

Nine hundred five cultures were performed on 679 patients. Forty-eight (7.1%) cases were matched to 144 controls. One hundred fifty-eight patients were screened upon hospital admission and 521 prior to LTAC admission. Independent predictors for CRE colonization included Charlson's score greater than 3 (odds ratio [OR], 4.85 [95% confidence interval (CI), 1.64–14.41]), immunosuppression (OR, 3.92 [95% CI, 1.08–1.28]), presence of indwelling devices (OR, 5.21 [95% CI, 1.09–2.96]), and prior antimicrobial exposures (OR, 3.89 [95% CI, 0.71–21.47]). Risk factors among patients screened upon hospital admission were similar to the entire cohort. Among patients screened prior to LTAC admission, the characteristics of the CRE-colonized and noncolonized patients were similar.

Conclusions.

These results can be used to identify patients at increased risk for CRE colonization and to help target active surveillance programs in healthcare settings.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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