Abstract
BackgroundThe emergence and spread of Carbapenem-resistant Escherichia coli (CREC) is becoming a serious problem in Chinese hospitals, however, the data on this is scarce. Therefore, we investigate the risk factors for healthcare-associated CREC infection and study the incidence, antibiotic resistance and medical costs of CREC infections in our hospital.MethodsWe conducted a retrospective, matched case–control–control, parallel study in a tertiary teaching hospital. Patients admitted between January 2012 and December 2015 were included in this study. For patients with healthcare-associated CREC infection, two matched subject groups were created; one group with healthcare-associated CSEC infection and the other group without infection.ResultsMultivariate conditional logistic regression analysis demonstrated that prior hospital stay (<6 months) (OR:3.96; 95%CI:1.26–12.42), tracheostomy (OR:2.24; 95%CI: 1.14–4.38), central venous catheter insertion (OR: 8.15; 95%CI: 2.31–28.72), carbapenem exposure (OR: 12.02; 95%CI: 1.52–95.4), urinary system disease (OR: 16.69; 95%CI: 3.01–89.76), low hemoglobin (OR: 2.83; 95%CI: 1.46–5.50), and high blood glucose are associated (OR: 7.01; 95%CI: 1.89–26.02) with CREC infection. Total costs (p = 0.00), medical examination costs (p = 0.00), medical test costs (p = 0.00), total drug costs (p = 0.00) and ant-infective drug costs (p = 0.00) for the CREC group were significantly higher than those for the no infection group. Medical examination costs (p = 0.03), total drug costs (p = 0.03), and anti-infective drug costs (p = 0.01) for the CREC group were significantly higher than for the CSEC group. Mortality in CREC group was significantly higher than the CSEC group (p = 0.01) and no infection group (p = 0.01).ConclusionMany factors were discovered for acquisition of healthcare-associated CREC infection. CREC isolates were resistant to most antibiotics, and had some association with high financial burden and increased mortality.
Highlights
The emergence and spread of Carbapenem-resistant Escherichia coli (CREC) is becoming a serious problem in Chinese hospitals, the data on this is scarce
Study design and setting We conducted a retrospective, parallel, case–control–control study to identify the incidence, risk factors, antibiotic resistance, and medical costs associated with the acquisition of healthcare-associated carbapenem-resistant E.coli (CREC) infection among hospitalized patients treated at Xiangya Hospital, a 3500bed general hospital in Changsha, Hunan Province, Central South China
The CREC infection group was compared with a no infection group to assess the risk factors for acquisition of CREC infection; the CREC group was compared with the carbapenem-susceptible E.coli (CSEC) infection group to evaluate reasons for antibiotic resistance
Summary
The emergence and spread of Carbapenem-resistant Escherichia coli (CREC) is becoming a serious problem in Chinese hospitals, the data on this is scarce. We investigate the risk factors for healthcare-associated CREC infection and study the incidence, antibiotic resistance and medical costs of CREC infections in our hospital. Carbapenem-resistant Escherichia coli (CREC), as one class of CRE, has become a major threat in hospitals worldwide [4,5,6,7]. Carbapenem resistance in E.coli is an emerging problem that is mainly caused by plasmid-encoded carbapenemases [8,9,10,11,12,13]. As a result of the emergence of carbapenemases [14], antimicrobial resistance is increasing in most hospitals, and has become a global healthcare problem. CREC strains should be closely monitored because of their potential trend to spread in both hospital and community settings [15]
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