Risk factors for acquisition of carbapenem resistant Enterobacteriaceae in an acute tertiary care hospital in Singapore

Antimicrobial Resistance and Infection Control

Lai Chee Lee¹  Kwee Yuen Tan¹  Kue Bien How¹  Ismawati M. Amin¹  Soong Geck Tan¹  Yong Ming Tee¹  Moi Lin Ling¹ 

[1]Infection Control, Singapore General Hospital, Outram Road, Singapore 169608, Singapore

关键词: Epidemiology;    Risk factors;    Carbapenem resistant;    Enterobacteriaceae;   

Others  :  1220720
DOI  :  10.1186/s13756-015-0066-3

 received in 2015-03-24, accepted in 2015-05-28,  发布年份 2015

【 摘 要 】

Background

Carbapenem 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.

Method

A 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.

Results

CREs 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.

Conclusions

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.

【 授权许可】

   
2015 Ling et al.

【 图 表 】

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【 参考文献 】

• [1]Wei ZQ, Du XX, Yu YS et al.. Plasmid-mediated KPC-2 in a Klebsiella pneumoniae isolate from China. Antimicrob Agents Chemother. 2007; 51:763-5.
• [2]Rhee JY, Park YK, Shin JY et al.. KPC-producing extreme drug-resistant Klebsiella pneumoniae isolate from a patient with diabetes mellitus and chronic renal failure on hemodialysis in South Korea. Antimicrob Agents Chemother. 2010; 54:2278-9.
• [3]Chia JH, Su LH, Lee MH et al.. Development of high-level carbapenem resistance in Klebsiella pneumoniae among patients with prolonged hospitalization and carbapenem exposure. Microb Drug Resist. 2010; 16:317-25.
• [4]Balm MN, Ngan G, Jureen R, Lin RT, Teo J. Molecular characterization of newly emerged blaKPC-2-producing Klebsiella pneumoniae in Singapore. J Clin Microbiol. 2012; 50:475-6.
• [5]Yong D, Toleman MA, Giske CG et al.. Characterisation of a new metallo- β -lactamase gene, bla NDM-1, and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. Antimicrob Agents Chemother. 2009; 53:5046-54.
• [6]Chien JM, Koh TH, Chan KS et al.. Successful treatment of NDM-1 Klebsiella pneumoniae bacteraemia in a neutropenic patient. Scand J Infect Dis. 2012; 44:312-4.
• [7]Ng E, Earnest A, Lye DC et al.. The excess financial burden of multidrug resistance in severe gram-negative infections in Singaporean hospitals. Ann Acad Med Singapore. 2012; 41:189-93.
• [8]Ben-David D, Maor Y, Keller N et al.. Potential role of active surveillance in the control of a hospital-wide outbreak of carbapenem-resistant Klebsiella pneumoniae infection. Infect Control Hosp Epidemiol. 2010; 31:620-6.
• [9]Munoz-Price LS, Cuesta CDL, Adams S et al.. Successful eradication of a monoclonal strain of Klebsiella pneumoniae during a K. pneumoniae carbapenemase-producing K. pneumoniae outbreak in a surgical intensive care unit in Miami, Florida. Infect Control Hosp Epidemiol. 2010; 31:1074-7.
• [10]Lerner A, Abu-Hanna K, Meitus I et al.. Environmental contamination by carbapenem-resistant Enterobacteriaceae. J Clin Microbiol. 2013; 51:177-81.
• [11]Kotsanas D, Wijesooriay WR, Korman TM et al.. “Down the drain”: carbapenem-resistant bacteria in intensive care unit patients and handwashing sinks. Med J Aust. 2013; 198:267-9.
• [12]Kritsotakis EI, Tsioutis C, Roumbelaki M et al.. Antibiotic use and the risk of carbapenem-resistant extended spectrum-β-lactamase-producing Klebsiella pneumoniae infection in hospitalized patients: results of a double case–control study. J Antimicrob Chemother. 2011; 66:1383-91.
• [13]Schechner V, Kotlovsky T, Tarabeia J et al.. Predictors of rectal carriage of carbapenem-resistant Enterobacteriaceae (CRE) among patients with known CRE carriage at their next hospital encounter. Infect Control Hosp Epidemiol. 2011; 32:497-503.
• [14]Patel N, Harrington S, Dihmess A et al.. Clinical epidemiology of carbapenem-intermediate or –resistant Enterobacteriaceae. J Antimicrob Chemother. 2011; 66:1600-8.
• [15]Liu S, Chang H, Chia J et al.. Outcomes and characteristics of ertapenem non-susceptible Klebsiella pneumoniae bacteremia at a university hospital in Northern Taiwan: a matched case-control study. J Microbiol Immunol Infect. 2012; 45:113-9.
• [16]Lee GC, Lawson KA, Burgess DS. Clinical epidemiology of carbapenem-resistant Enterobacteriaceae in community hospitals: a case-case-control study. Ann Pharmacother. 2013; 47:1115-21.
• [17]Bhargava A, Hayakawa K, Silverman E et al.. Risk factors for colonization due to carbapenem-resistant Enterobacteriaceae among patients exposed to long-term acute care and acute care facilities. Infect Control Hosp Epidemiol. 2014; 35:398-405.
• [18]Borer A, Saidel-Odes L, Eskira S et al.. Risk factors for developing clinical infection with carbapenem-resistant Klebsiella pneumoniae in hospital patients initially only colonized with carbapenem-resistant K pneumoniae. Am J Infect Control. 2012; 40:421-5.
• [19]Falagas ME, Rafailidis PI, Kofteridis D et al.. Risk factors of carbapenem-resistant Klebsiella pneumoniae infections: a matched case control study. J Antimicrob Chemother. 2007; 60:1124-30.
• [20]Rosenthal VD, Maki DG, Salomao R et al.. Device-associated nosocomial infections in 55 intensive care units of 8 developing countries. Ann Intern Med. 2006; 145:582-91.
• [21]Moreno CA, Rosenthal VD, Olarte N et al.. Device-associated infection rate and mortality in intensive care units of 9 Colombian hospitals: findings of the International Nosocomial Infection Control Consortium. Infect Control Hosp Epidemiol. 2006; 27:349-56.
• [22]Whitley E, Ball J. Statistics Review 4. Sample size calculations. Crit Care. 2002; 6:335-41. BioMed Central Full Text
• [23]Chitnis AS, Caruthers PS, Rao AK et al.. Outbreak of carbapenem-resistant Enterobacteriaceae at a long-term acute care hospital: sustained reductions in transmission through active surveillance and targeted interventions. Infect Control Hosp Epidemiol. 2012; 33:984-92.