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Predictors of Rectal Carriage of Carbapenem-Resistant Enterobacteriaceae (CRE) among Patients with Known CRE Carriage at Their Next Hospital Encounter

Published online by Cambridge University Press:  02 January 2015

Vered Schechner ,
Tali Kotlovsky ,
Jalal Tarabeia ,
Meital Kazma ,
David Schwartz ,
Shiri Navon-Venezia  and
Yehuda Carmeli
Vered Schechner*
Affiliation:
Division of Epidemiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Tali Kotlovsky
Affiliation:
Division of Epidemiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Jalal Tarabeia
Affiliation:
Division of Epidemiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Meital Kazma
Affiliation:
Division of Epidemiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
David Schwartz
Affiliation:
Clinical Microbiology Laboratory, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Shiri Navon-Venezia
Affiliation:
Division of Epidemiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Yehuda Carmeli
Affiliation:
Division of Epidemiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
*
Division of Epidemiology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel, ([email protected])
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Abstract

Background.

Carbapenem-resistant Enterobacteriaceae (CRE) are important extremely drug-resistant pathogens that have emerged during the past decade. Early identification and isolation of carriers are key components of an effective infection control strategy in healthcare facilities. Very little is known about the natural history of CRE carriage. We aimed to determine the predictors of a positive CRE rectal screen test among patients with known CRE carriage screened at their next hospital encounter.

Methods.

A case-control study was conducted. Sixty-six patients who tested positive for CRE carriage were surveyed for CRE rectal carriage at the next hospital encounter; screen-positive patients were compared with screen-negative control patients. Data were extracted from the patients' medical records and from the hospital computerized database.

Results.

Twenty-three case patients and 43 control patients were identified. Predictors for a positive CRE rectal carriage test were (1) prior fluoroquinolone use (odds ratio [OR], 4.27; 95% confidence interval [CI], 1.10–16.6), (2) admission from an institution or another hospital (OR, 4.04; 95% CI, 1.33–12.37), and (3) time interval less than or equal to 3 months since the first positive CRE test (OR, 3.59; 95% CI, 1.24–10.37). Among patients with no predictor variables, the likelihood of having a positive screen test at the next hospital encounter was 1/7. If they had at least 1 predictor, the likelihood increased to 1/2.

Conclusions.

Prior fluoroquinolone use, transfer from another healthcare facility, and admission less than or equal to 3 months since the first CRE isolation are predictors of persistent CRE rectal carriage. These predictors can be used in designing CRE prevention strategies.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 5 , May 2011 , pp. 497 - 503
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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