Abstract
BackgroundCarbapenem resistant Enterobacteriaceae (CRE) is increasingly reported worldwide. A similar increase is seen in Singapore since identification of its first case in 2008. The aim of this study was to identify local risk factors for carriage of CRE in patients from an acute tertiary care hospital in Singapore.MethodA matched case-control study was conducted on inpatients treated from January 1, 2011 till December 31, 2013. Two hundred and three cases of CRE infection or colonization were matched with 203 controls. CRE types were identified by PCR. Statistical analysis of data including a multivariate logistic regression analysis was done using SPSS 21.0.ResultsCREs were commonly seen in Klebsiella pneumoniae (42.2 %), Escherichia coli (24.3 %) and Enterobacter cloacae complex (17.2 %) in the 268 isolates. NDM-1 was the commonest CRE type seen (44.4 %), followed by KPC (39.9 %) whilst OXA-48 only constituted (7.8 %). Univariate analysis identified key risk factors associated with CRE as history of previous overseas hospitalization (OR: 33.667; 95 % CI: 4.539-259.700), admission to ICU (OR: 11.899; 95 % CI: 4.986-28.399) and HD/ICA (OR: 6.557; 95 % CI: 4.057-10.596); whilst a multivariate analysis revealed exposure to antibiotics penicillin (OR: 4.640; 95 % CI: 1.529-14.079] and glycopeptide (OR: 5.162; 95 % CI: 1.377-19.346) and presence of central line device (OR: 3.117; 95 % CI: 1.167-8.330) as significant independent predictors.ConclusionsThe identification of risk factors amongst our local population helped to refine the criteria used for target active surveillance screening for CRE amongst inpatients at time of hospital admission.
Highlights
Carbapenem resistant Enterobacteriaceae (CRE) is increasingly reported worldwide with increasing awareness of the global problem and improved methods of laboratory identification
Univariate analysis identified key risk factors associated with CRE as history of previous overseas hospitalization (OR: 33.667; 95 % confidence intervals (CIs): 4.539-259.700), admission to intensive care unit (ICU) (OR: 11.899; 95 % CI: 4.986-28.399) and HD/ICA (OR: 6.557; 95 % CI: 4.057-10.596); whilst a multivariate analysis revealed exposure to antibiotics penicillin (OR: 4.640; 95 % CI: 1.529-14.079] and glycopeptide (OR: 5.162; 95 % CI: 1.377-19.346) and presence of central line device (OR: 3.117; 95 % CI: 1.167-8.330) as significant independent predictors
The identification of risk factors amongst our local population helped to refine the criteria used for target active surveillance screening for CRE amongst inpatients at time of hospital admission
Summary
Carbapenem resistant Enterobacteriaceae (CRE) is increasingly reported worldwide with increasing awareness of the global problem and improved methods of laboratory identification. After the first discovery of the first NDM-1 patient at the Singapore General Hospital (SGH) in 2008, we noticed a steady gradual rise in the number of CRE patients in the subsequent years [5, 6]. There is the risk of potential nosocomial CRE outbreaks arising from environmental contamination or lapses in infection control practices [8,9,10,11] In light of these challenges and the fact that there are limited therapeutic options for the management of patients with CRE infections, we conducted a case-control study with the main objectives of identifying risk factors for carriage of CRE in our patients and enhancing existing strategies in controlling the spread of CRE amongst inpatients at our hospital.
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