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Infection control and risk factors for acquisition of carbapenemase-producing enterobacteriaceae. A 5 year (2011-2016) case-control study.
Antimicrobial Resistance & Infection Control ( IF 5.5 ) Pub Date : 2020-01-17 , DOI: 10.1186/s13756-019-0668-2
Luigi Segagni Lusignani 1 , Elisabeth Presterl 1 , Beata Zatorska 1 , Miriam Van den Nest 1 , Magda Diab-Elschahawi 1
Affiliation  

Background Carbapenemase-producing enterobacteriaceae (CPE) are a major threat for severely ill patients. However, only limited data on the epidemiology and on evidence-based infection prevention and control measures are available. The aim of this study was to investigate the epidemiology of patients with CPE, characterizing the CPE isolates by their resistance mechanisms and genetic similarity, to explore risk factors for their acquisition, and to evaluate the effectiveness of the current CPE infection control measures. Methods A retrospective case-control study was performed using data from 2011 to 2016 in a 1800-bed academic hospital in Central Europe, where risk-based screening at patients´ admission is performed. Carbapenem resistance mechanisms of all carbapenem resistant enterobacteriaceae from patients admitted during this period were investigated. Clinical data of the CPE-positive patients were analysed and compared to a matched control group (case-control ratio of 1:3). We performed univariate and multivariate statistical analysis to identify risk factors for CPE acquisition. Results Of 621,623 admitted patients in the study period, 75 patients with carriage of carbapenem resistant enterobacteriaceae were included (0.12/1000 admittances). Carbapenemase-encoding genes were detected in 77.3% (58/75) of patients with carbapenem-resistant enterobacteriaceae. The enzyme blaOXA-48 was found in 34.5% (20/58), blaKPC in 29.3% (17/58), blaNDM enzymes in 20.7% (12/58) and blaVIM in 8.6% (5/58) of the isolates. The overall mortality among CPE patients was 25.9% (15/58) and attributable mortality of CPE was 53.3% (8/15). Multivariate analysis revealed four risk factors to be independent predictors of CPE carriage: the length of hospital admission > 20 days (AOR: 4.9, 95% CI: 1.4-15.5; P <  0.001), hospital admission within the previous year (AOR: 22.3, 95% CI: 3.9-88.4; P <  0.001), exposure to a healthcare facility in a country with high or unknown carbapenem-resistant enterobacteriaceae prevalence 3 months before admission (AOR: 11.8, 95% CI: 2.2-63.2; P <  0.01) and the use of antibiotics longer than 10 days (AOR: 5.2, 95% CI: 1.4-35.9; P <  0.05). The current risk-based screening strategy at hospital admission could not identify 37 (63.8%) of the 58 CPE-positive patients. Epidemiological investigation and genotyping revealed that no outbreaks due to CPE occurred during this period. Conclusion Overall, the CPE carriage rate in patients was very low, the attributable mortality, however, is alarming (53%). BlaOXA-48 and blaKPC were the main cause of carbapenem resistance in enterobacteriaceae. Although the strict application of standard infection control measures was effective for prevention of outbreaks in this setting, an enlarged risk based targeted screening strategy has to be implemented.

中文翻译:

感染控制和获得产生碳青霉烯酶的肠杆菌科的危险因素。一项为期5年(2011-2016年)的病例对照研究。

背景产生碳青霉烯酶的肠杆菌科(CPE)是重症患者的主要威胁。但是,关于流行病学以及基于证据的感染预防和控制措施的数据很少。这项研究的目的是调查CPE患者的流行病学,通过其耐药机制和遗传相似性来表征CPE分离株,探索其获取的危险因素,并评估当前CPE感染控制措施的有效性。方法使用2011年至2016年在中欧一家拥有1800张床位的学术医院中的数据进行回顾性病例对照研究,对患者入院时进行基于风险的筛查。研究了在此期间入院的所有对碳青霉烯类耐药的肠杆菌科细菌对碳青霉烯类的耐药机制。分析了CPE阳性患者的临床数据,并将其与匹配的对照组进行比较(病例对照率为1:3)。我们进行了单因素和多因素统计分析,以确定CPE收购的风险因素。结果在研究期间的621,623例入院患者中,包括了75例携带碳青霉烯耐药肠杆菌科的患者(入院率为0.12 / 1000)。在77.3%(58/75)的耐碳青霉烯性肠杆菌科患者中检出了碳青霉烯酶编码基因。在分离物中发现了blaOXA-48酶(34.5%(20/58),blaKPC 29.3%(17/58),blaNDM酶20.7%(12/58)和8.6%(5/58)的blaVIM。CPE患者的总死亡率为25。CPE为9%(15/58),可归因的死亡率为53.3%(8/15)。多因素分析显示四个危险因素是CPE携带的独立预测因素:入院时间> 20天(AOR:4.9,95%CI:1.4-15.5; P <0.001),上一年内入院(AOR:22.3) ,95%CI:3.9-88.4; P <0.001),在入院前3个月暴露于对碳青霉烯耐药肠杆菌的患病率较高或未知的国家的医疗机构中(AOR:11.8,95%CI:2.2-63.2; P < 0.01)和使用超过10天的抗生素(AOR:5.2,95%CI:1.4-35.9; P <0.05)。目前在住院时基于风险的筛查策略无法识别58例CPE阳性患者中的37例(63.8%)。流行病学调查和基因分型显示,在此期间未发生因CPE引起的暴发。结论总体而言,患者的CPE携带率非常低,但是可归因的死亡率令人震惊(53%)。BlaOXA-48和blaKPC是肠杆菌科细菌对碳青霉烯耐药的主要原因。尽管在这种情况下严格应用标准的感染控制措施可以有效预防疾病爆发,但是必须实施基于风险的扩大的有针对性的筛查策略。
更新日期:2020-04-22
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