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Risk Factors for Recurrence of Carbapenem-Resistant Enterobacteriaceae Carriage: Case-Control Study

Published online by Cambridge University Press:  14 April 2015

Yossi Bart ,
Mical Paul ,
Orna Eluk ,
Yuval Geffen ,
Galit Rabino  and
Khetam Hussein
Yossi Bart
Affiliation:
Rappaport Faculty of Medicine and Research Institute, Technion–Israel Institute of Technology, Haifa, Israel
Mical Paul
Affiliation:
Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
Orna Eluk
Affiliation:
Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
Yuval Geffen
Affiliation:
Rappaport Faculty of Medicine and Research Institute, Technion–Israel Institute of Technology, Haifa, Israel Clinical Microbiology Laboratory, Rambam Health Care Campus, Haifa, Israel
Galit Rabino
Affiliation:
Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
Khetam Hussein*
Affiliation:
Rappaport Faculty of Medicine and Research Institute, Technion–Israel Institute of Technology, Haifa, Israel Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
*
Address correspondence to Khetam Hussein, MD, Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel ([email protected]).
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Abstract

BACKGROUND

The natural history of carbapenem-resistant Enterobacteriaceae (CRE) carriage and the timing and procedures required to safely presume a CRE-free status are unclear.

OBJECTIVE

To determine risk factors for recurrence of CRE among presumed CRE-free patients.

METHODS

Case-control study including CRE carriers in whom CRE carriage presumably ended, following at least 2 negative screening samples on separate days. Recurrence of CRE carriage was identified through clinical samples and repeated rectal screening in subsequent admissions to any healthcare facility in Israel. Patients with CRE recurrence (cases) were compared with recurrence-free patients (controls). The duration of follow-up was 1 year for all surviving patients.

RESULTS

Included were 276 prior CRE carriers who were declared CRE-free. Thirty-six persons (13%) experienced recurrence of CRE carriage within a year after presumed eradication. Factors significantly associated with CRE recurrence on multivariable analysis were the time in months between the last positive CRE sample and presumed eradication (odds ratio, 0.94 [95% CI, 0.89–0.99] per month), presence of foreign bodies at the time of presumed eradication (4.6 [1.64–12.85]), and recurrent admissions to healthcare facilities during follow-up (3.15 [1.05–9.47]). The rate of CRE recurrence was 25% (11/44) when the carrier status was presumed to be eradicated 6 months after the last known CRE-positive sample, compared with 7.5% (10/134) if presumed to be eradicated after 1 year.

CONCLUSIONS

We suggest that the CRE-carrier status be maintained for at least 1 year following the last positive sample. Screening of all prior CRE carriers regardless of current carriage status is advised.

Infect. Control Hosp. Epidemiol. 2015;36(8):936–941

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 8 , August 2015 , pp. 936 - 941
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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