Prevalence and Risk Factors of Carbapenem-resistant Enterobacteriaceae Acquisition in an Emergency Intensive Care Unit in a Tertiary Hospital in Korea: a Case-Control Study

• Published in: Journal of Korean medical science 2019, 34(18), , pp.1-11
• Main Authors: Kang, Jin Suk, Yi, Jongyoun, Ko, Mee Kyung, Lee, Soon Ok, Lee, Jeong Eun, Kim, Kye Hyung
• Format: Article
• Language: English
• Subjects: Acinetobacter baumannii - isolation & purification; Adolescent; Adult; Aged; Aged, 80 and over; Carbapenem-Resistant Enterobacteriaceae - isolation & purification; Case-Control Studies; Drug Resistance, Multiple, Bacterial; Enterobacteriaceae Infections - diagnosis; Enterobacteriaceae Infections - epidemiology; Enterobacteriaceae Infections - microbiology; Female; Humans; Intensive Care Units; Klebsiella pneumoniae - isolation & purification; Male; Middle Aged; Odds Ratio; Original; Prevalence; Republic of Korea - epidemiology; Risk Factors; Tertiary Care Centers; Young Adult; 의학일반
• ISSN: 1011-8934; 1598-6357
• DOI: 10.3346/jkms.2019.34.e140

Infections caused by carbapenem-resistant (CRE) are associated with high mortality rates and their treatment is difficult because treatment is limited to certain antibiotics, such as colistin and tigecycline. We aimed to perform active surveillance culture of CRE (ASC-CRE) to monitor the prevalence of CRE acquisition during intensive care unit (ICU) care and to examine the potential risk factors associated with CRE acquisition. We conducted ASC-CRE on patients who were admitted to the ICU in the emergency room at a tertiary hospital. Rectal swabs were analyzed using methods established by the Centers for Disease Control and Prevention. To detect carbapenemase-producing CRE, a polymerase chain reaction assay to detect five carbapenemase genes ( , , , , and ) was performed. There were 22 CRE acquisition in 21 patients (2.6%, 21/810) and the incidence of CRE acquisition was 4.3/1,000 person-days, respectively. The most common species detected was (72.7%, 16/22), and 9 carbapenemase-producing CREs (7 and 2 ) were detected. Independent risk factors associated with CRE acquisition were men gender (adjusted odds ratio [aOR], 5.3; 95% confidence interval [CI], 1.3-21.3), history of admission within one year (aOR, 3.9; 95% CI, 1.2-12.1), co-colonization with multidrug-resistant (aOR, 15.6; 95% CI, 3.6-67.8) and extended-spectrum β-lactamases-producing bacteria (aOR, 4.7; 95% CI, 1.5-14.6), and exposure to glycopeptide antibiotics (aOR, 3.6; 95% CI, 1.3-9.9). The identification of patients with risk factors for CRE acquisition and early detection of CRE acquisition using ASC-CRE may be useful for CRE control.