Korean Journal of Clinical Pharmacy (한국임상약학회지)

Korean College Of Clinical Pharmacy (한국임상약학회)
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Risk Factors of Carbapenem-resistant Enterobacteriaceae Acquisition at a Community-based Hospital

지역기반 상급종합병원 내 카바페넴 내성 장내세균 획득에 관한 위험인자

  • Lee, Yeonju (Graduate School of Converging Clinical & Public Health, Ewha Womans University) ;
  • Kang, Ji Eun (College of Pharmacy, Ewha Womans University) ;
  • Ham, Jung Yeon (Department of Pharmacy, Kangbuk Samsung Medical Center) ;
  • Lee, Ja Gyun (Department of Pharmacy, Kangbuk Samsung Medical Center) ;
  • Rhie, Sandy Jeong (Graduate School of Converging Clinical & Public Health, Ewha Womans University)
  • 이연주 (이화여자대학교 임상보건융합대학원) ;
  • 강지은 (이화여자대학교 약학대학) ;
  • 함정연 (강북삼성병원 약제부) ;
  • 이자균 (강북삼성병원 약제부) ;
  • 이정연 (이화여자대학교 임상보건융합대학원)
  • Received : 2020.06.05
  • Accepted : 2020.06.14
  • Published : 2020.06.30
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Abstract

Objective: The rising number of carbapenemase-resistant Enterobacteriaceae (CRE) cases has become a concern worldwidely. This study investigated patient characteristics with CRE and analyzed the risk factors associated with its acquisition. Methods: A retrospective review of the electronic medical records of the Kangbuk Samsung Medical Center from May 2016 to April 2019 was performed. The inclusion criterion was hospitalized patients aged ≥18 years with confirmed CRE acquisition. Patients were divided by CRE acquired and non-required patients. CRE acquired patients were those with CRE confirmed by their active surveillance cultures, while non-acquired patients were those with carbapenemase-sensitive Enterobacteriaceae (CSE). If CRE was isolated more than once during hospitalization, only the first isolation was used for data analysis. Patient characteristics, antibiotic used, and the duration of use were compared between two groups using univariate analysis, and the risk factors associated with CRE were analyzed using multiple logistic regression analysis. Results: Among the 73 CRE acquired patients, 44 (60.3%) were positive for carbapenemase-producing Enterobacteriaceae (CPE). Infection from Klebsiella pneumonia (42 cases, 57.5%), Escherichia coli (17 cases, 23.3%), and Enterobacter cloacae (5 cases, 6.8%). The risk of CRE acquisition was significantly increased by 4.99 times [confidence interval (CI), 1.40-17.78; p=0.013] with mechanical ventilation, 3.86 times (CI, 1.59-9.36; p=0.003) with penicillin administration, and 21.19 times (CI, 6.53-68.70; p<0.001) with carbapenem administration. Conclusions: Proper antibiotic use including the selection, frequency, and duration, and patients on mechanical ventilators need close monitoring.

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References

  1. Kaniga K, Flamm R, Tong SY, Lee M, Friedland I, Redman R. Worldwide experience with the use of doripenem against extendedspectrum-beta-lactamase-producing and ciprofloxacin-resistant Enterobacteriaceae: analysis of six phase 3 clinical studies. Antimicrob Agents Chemother. 2010;54(5):2119-24.
  2. Queenan AM, Bush K. Carbapenemases: the versatile betalactamases. Clin Microbiol Rev. 2007;20(3):440-58. https://doi.org/10.1128/CMR.00001-07
  3. Naas T. and Nordmann P. Analysis of a carbapenem-hydrolyzing class A beta-lactamase from Enterobacter cloacae and of its LysRtype regulatory protein. Proc Natl Acad Sci USA. 1994;91(16): 7693-97.
  4. Korea Centers for Disease Control and Prevention 2018. Guidelines for healthcare assosicated infectious disease (VRSA, CRE). Government publications registration number 11-1352159-00832-10.
  5. World Health Organization 2017. Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities. Geneva: WHO Document Production services, 2017.
  6. Kim YK, Song SA, Lee JN et al. Clinical factors predicting persistent carriage of Klebsiella pneumoniae carbapenemaseproducing carbapenem-resistant Enterobacteriaceae among patients with known carriage. J Hosp Infect. 2018;99(4):405-12. https://doi.org/10.1016/j.jhin.2017.10.017
  7. Chabah M, Chemsi M, Zerouali K et al. Healthcare-associated infections due to carbapenemase-producingEnterobacteriaceae: Bacteriological profile and risk factors. Med Mal Infect. 2016;46(3):157-62. https://doi.org/10.1016/j.medmal.2015.12.015
  8. Salomal MC, Guimaraes T, Duailibi DF et al. Carbapenem-resistant Enterobacteriaceae in patients admitted to the emergency department: prevalence, risk factors, and acquisition rate. J Hosp Infect. 2017;97(3):241-6. https://doi.org/10.1016/j.jhin.2017.08.012
  9. Lee HJ, Choi JK, Cho SY et al. Carbapenem-resistant enterobacteriaceae: prevalence and risk factors in a single community-based hospital in Korea. Infect Chemother. 2016;48(3):166-73. https://doi.org/10.3947/ic.2016.48.3.166
  10. Papst L, Beovic B, Pulcini C et al. Antibiotic treatment of infections caused by carbapenem-resistant gram-negative bacilli: an international ESCMID cross-sectional survey among infectious diseases specialists practicing in large hospitals. Clin Microbiol Infect. 2018;24(10):1070-6.
  11. Peri AM, Doi Y, Potoski BA, Harris PNA, Paterson DL, Righi E. Antimicrobial treatment challenges in the era of carbapenem resistance. Diagn Microbiol Infect Dis. 2019;94(4):413-25. https://doi.org/10.1016/j.diagmicrobio.2019.01.020
  12. Bassetti M, Peghin M, Pecori D. The management of multi-drugresistant enterobacteriaceae. Curr Opin Infect Dis. 2016;29(6):583-94. https://doi.org/10.1097/QCO.0000000000000314
  13. King M, Heil E, Kuriakose S et al. Multicenter study of outcomes with ceftazidime-avibactam in patients with carbapenem-resistant enterobacteriaceae infections. Antimicrob Agents Chemother. 2017;61(7).
  14. Papadimitriou-Olivgeris M, Bartzavali C, Spyropoulou A et al. Molecular epidemiology and risk factors for colistin- or tigecyclineresistant carbapenemase-producing Klebsiella pneumoniae bloodstream infection in critically ill patients during a 7-year period. Diagn Microbiol Infect Dis. 2018;92(3):235-40. https://doi.org/10.1016/j.diagmicrobio.2018.06.001
  15. Durante-Mangoni E, Andini R, Zampino R. Management of carbapenem-resistant Enterobacteriaceae infections. Clin Microbiol Infect. 2019;25(8):943-50.
  16. Yamamoto N, Asada R, Kawahara R, et al. Prevalence of, and risk factors for, carriage of carbapenem-resistant Enterobacteriaceae among hospitalized patients in Japan. J Hosp Infect. 2017;97(3):212-17. https://doi.org/10.1016/j.jhin.2017.07.015
  17. McConville TH, Sullivan SB, Gomez-Simmonds A, Whittier S, Uhlemann AC. Carbapenem-resistant Enterobacteriaceae colonization (CRE) and subsequent risk of infection and 90-day mortality in critically ill patients, an observational study. PLoS One. 2017; 12(10):e0186195. https://doi.org/10.1371/journal.pone.0186195
  18. Ling ML, Tee YM, Tan SG, et al. Risk factors for acquisition of carbapenem resistant Enterobacteriaceae in an acute tertiary care hospital in Singapore. Antimicrob Resist Infect Control. 2015;4:26. https://doi.org/10.1186/s13756-015-0066-3
  19. Lavagnoli LS, Bassetti BR, Kaiser TDL, Kutz KM, Cerutti C Junior. Factors associated with acquisition of carbapenem-resistant Enterobacteriaceae1. Rev Lat Am Enfermagem. 2017;25: e2935.
  20. Kang JS, Yi J, Ko MK, Lee SO, Lee JE, Kim KH. 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. J Korean Med Sci. 2019;34(18):e140. https://doi.org/10.3346/jkms.2019.34.e140