Differences in the incidence of Carbapenem Resistant Enterobacteriae (CRE) and Vancomycin-resistant Enterococcus (VRE) in a major teaching hospital and factors with possible impact

Abstract

Background: In the last year we have observed an increase in CRE in hospitalized patients but not in VRE inspite of discontinuation of isolation measures. Studies have associated CRE colonization with the changes in the microbiota (like Clostridium butyricum), caused by antibiotics.Methods & Materials: Descriptive, retrospective.Tabled 1Results: Annual incidence of MDRO, first clinical sample >72 hours of admission, 1000 patient days.20132014201520162017CRE0.41 (CI 95% 0.316; 0.518)0,28 (CI 95% 0.207; 0.375)0.22 (CI 95% 0.156; 0.3)0.24 (CI 95% 0.17; 0.317)0.48(0.355; 0.634)VRE0.23 (CI 95% 0.16; 0.32),0.04 (CI 95% 0.017; 0.09)0.11 (CI 95% 0.06; 0.17),0.18 (CI 95% 0.12; 0.25,0.11(0.0538; 0.192). Open table in a new tab Tabled 1Factors20132014201520162017Hand hygiene compliance (%).62.8% (CI 95% 61.26; 64.4) (CI 95% 73; 75.26)72.4(CI 95% 71.07; 73.6)65.5(CI 95% 64.27; 66.77)64.8 (CI 95% 63.8; 65.7)74.1 (CI 95% 73; 75.26)Broad spectrum antibiotic consumption, days of therapy, 1000 patient days (vancomycin, carbapenem, tigecycline, piperacilintazobactam and linezolid).174,75 (95% CI 172.9; 176.6)175.68 (173.8; 177.5),190.23 (188.3; 192.1)187.14 (181.2; 192.9)193.16 (186.2; 200). Open table in a new tab In 2016 contact precautions were discontinued for VRE and remained por CRE. Hand hygiene increases significantly in 2017 P 0.000. The antibiotics combined increase significantly from 2014 to 2015 RR 1.08 (95% CI 1.07; 1.1). Conclusion: Comparing multidrug resistant organisms (MDRO) with gastrointestinal carriage, the rate of VRE remains stable and CRE continues to rise without an outbreak pattern. Antibiotic consumption is also on the rise. Despite the Antimicrobial Stewardship Programs, the same increase in the incidence of the MDRO promotes its use. Perhaps the time has come to consider also new tools such as probiotics and fecal microbiota therapy, focusing on the microbiota to resist colonization by CRE.