Abstract
BackgroundSearching the risk factors for carbapenem-resistant Enterobacteriaceae (CRE) infection is important in clinical practice. In the present study, we aim to investigate bacterial characteristics of colonizing strains and their correlation with subsequent CRE infection.MethodsBetween May 2018 and January 2019, patients hospitalized in the department of haematology and intensive care unit (ICU) were screened for CRE by rectal swabs and monitored for the outcome of infection. We identified the species and carbapenemase-encoding genes of colonizing strains and performed antimicrobial susceptibility tests and multilocus sequence typing (MLST). Risk factors for subsequent CRE infections were ascertained by univariate and multivariable analysis.ResultsWe collected a total of 219 colonizing strains from 153 patients. Klebsiella pneumoniae was the most abundant species, and MLST analysis showed rich diversity. K. pneumoniae carbapenemase (KPC) was predominant in the infection group (72.4%). In the non-infection group, 35.4% of strains were non-carbapenemase-producing CRE (NCP-CRE), and New Delhi metallo-β-lactamase (NDM) was predominant (42.2%). The rate of high-level carbapenem resistance (minimum inhibitory concentration [MIC] ≥ 64 mg/L for meropenem and ertapenem, ≥ 32 mg/L for imipenem) was remarkably higher in the infection group than in the non-infection group (P < 0.001). Univariate analysis showed that K. pneumoniae, high-level carbapenem resistance, CP-CRE and KPC-CRE were infection risk factors after CRE colonization. On multivariable analysis with different carbapenemase dichotomizations, KPC-CRE (adjusted odds ratio [aOR], 4.507; 95% confidence interval [CI], 1.339–15.171; P = 0.015) or imipenem MIC ≥ 32 mg/L (aOR, 9.515; 95% CI, 1.617–55.977; P = 0.013) were respectively identified as independent risk factors for subsequent infection.ConclusionsPatients colonized with KPC-CRE or strains with an imipenem MIC ≥ 32 mg/L were at particularly high risk of subsequent CRE infections during their hospital stay.
Highlights
Searching the risk factors for carbapenem-resistant Enterobacteriaceae (CRE) infection is important in clinical practice
Patients colonized with K. pneumoniae carbapenemase (KPC)-CRE or strains with an imipenem minimum inhibitory concentration (MIC) ≥ 32 mg/L were at high risk of subsequent CRE infections during their hospital stay
We found that imipenem MIC ≥ 32 mg/L or Klebsiella pneumoniae carbapenemase (KPC)-positive CRE-colonized patients were at high risk of subsequent CRE infections during their hospital stay
Summary
Searching the risk factors for carbapenem-resistant Enterobacteriaceae (CRE) infection is important in clinical practice. Carbapenem-resistant Enterobacteriaceae (CRE) infections are of major concern to clinicians and public health authorities due to increasing prevalence, rapid regional dissemination, limited therapeutic options and deleterious patient outcomes (mortality rates are 40 ± 10%) [1]. A series of clinical reports have shown that individually or nationally directed infection control interventions can effectively reduce CRE transmission and infection rates [4,5,6]. Researchers have increasingly explored strategies to decolonize CRE to interrupt pathways between colonization and subsequent infections [10,11,12,13]. Searching CRE colonization patients who are at high risk of infection is an urgent priority, as it can guide us whether additional interventions are needed and limit decolonization strategy use
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