Prevalence and Risk Factors for Acquisition of Carbapenem-Resistant Enterobacteriaceae in the Setting of Endemicity

2013 ◽  
Vol 34 (8) ◽  
pp. 809-817 ◽  
Author(s):  
Mahesh Swaminathan ◽  
Saarika Sharma ◽  
Stephanie Poliansky Blash ◽  
Gopi Patel ◽  
David B. Banach ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Control Program ◽  
Case Control ◽  
Case Definition ◽  
Colonization Pressure ◽  
Carbapenem Resistant ◽  
Nested Case Control ◽  
Control Study ◽  
Carbapenem Resistant Enterobacteriaceae

Objective.To describe the epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) carriage and acquisition among hospitalized patients in an area of CRE endemicity.Design.Cohort study with a nested case-control study.Setting.Two acute care, academic hospitals in New York City.Participants.All patients admitted to 7 study units, including intensive care, medical-surgical, and acute rehabilitation units.Method.Perianal samples were collected from patients at admission and weekly thereafter to detect asymptomatic gastrointestinal carriage of CRE. A nested case-control study was performed to identify factors associated with CRE acquisition. Case patients were those who acquired CRE during a single hospitalization. Control subjects had no microbiologic evidence of CRE and at least 1 negative surveillance sample. Clinical data were abstracted from the medical record.Results.The prevalence of CRE in the study population was 5.4% (306 of 5,676 patients), and 104 patients met the case definition of acquisition during a single hospital stay. Mechanical ventilation (odds ratio [OR], 11.5), pulmonary disease (OR, 5.2), days of antibiotic therapy (OR, 1.04), and CRE colonization pressure (OR, 1.15) were independently associated with CRE acquisition. Pulsed-field gel electrophoresis analysis identified 87% of tested Klebsiella pneumoniae isolates as sharing related patterns (greater than 78% similarity), which suggests clonal transmission within and between the study hospitals.Conclusions.Critical illness and underlying medical conditions, CRE colonization pressure, and antimicrobial exposure are important risk factors for CRE acquisition. Adherence to infection control practices and antimicrobial stewardship appear to be critical components of a CRE control program.

Risk factors for carbapenem resistant enterobacteriaceae in a teritiary hospital—A case control study

2018 ◽  
Vol 9 (4) ◽  
pp. 178-183 ◽  
Author(s):  
Muralidhar Varma ◽  
L. Rohit Reddy ◽  
Vandana ◽  
Sudha Vidyasagar ◽  
Avinash Holla ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Case Control ◽  
Carbapenem Resistant ◽  
Control Study ◽  
Carbapenem Resistant Enterobacteriaceae

scholarly journals Risk factors of carbapenem-resistant Enterobacteriaceae infection and colonisation: a Malaysian tertiary care hospital based case-control study

2021 ◽  
Vol 51 (1) ◽  
pp. 24-30
Author(s):  
Chuan Chuah ◽  
◽  
Yasmin Gani ◽  
Benedict Sim ◽  
Suresh Chidambaram
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Case Control ◽  
High Morbidity ◽  
Care Hospital ◽  
Carbapenem Resistant ◽  
Control Study ◽  
Carbapenem Resistant Enterobacteriaceae

Background Carbapenem-resistant Enterobacteriaceae (CRE) infection has become a major challenge to clinicians. The aim of this study is to identify the risk factors of acquiring CRE to guide more targeted screening for hospital admissions. Methods This is a retrospective case-control study (ratio 1:1) where a patient with CRE infection or colonisation was matched with a control. The control was an individual who tested negative for CRE but was a close contact of a patient testing positive and was admitted at the same time and place. Univariate and multivariate statistical analyses were done. Results The study included 154 patients. The majority of the CRE was Klebsiella species (83%). From univariate analysis, the significant risk factors were having a history of indwelling devices (OR: 2.791; 95% CI: 1.384–5.629), concomitant other MDRO (OR: 2.556; 95% CI: 1.144–5.707) and hospitalisation for more than three weeks (OR: 2.331; 95% CI: 1.163–4.673). Multivariate analysis showed that being unable to ambulate on admission (adjusted OR: 2.345; 95% CI: 1.170–4.699) and antibiotic exposure (adjusted OR: 3.515; 95% CI: 1.377–8.972) were independent predictors. The in-hospital mortality rate of CRE infection was high (64.5%). CRE acquisition resulted in prolonged hospitalisation (median=35 days; P<0.001). Conclusion CRE infection results in high morbidity and mortality. On top of the common risk factors, patients with mobility restriction, prior antibiotic exposures and hospitalisation for more than three weeks should be prioritised in the screening strategy to control the spread of CRE.

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

2015 ◽  
Vol 36 (8) ◽  
pp. 936-941 ◽  
Author(s):  
Yossi Bart ◽  
Mical Paul ◽  
Orna Eluk ◽  
Yuval Geffen ◽  
Galit Rabino ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Case Control ◽  
Positive Sample ◽  
Carrier Status ◽  
Carbapenem Resistant ◽  
Risk Factors For Recurrence ◽  
Control Study ◽  
Carbapenem Resistant Enterobacteriaceae

BACKGROUNDThe natural history of carbapenem-resistant Enterobacteriaceae (CRE) carriage and the timing and procedures required to safely presume a CRE-free status are unclear.OBJECTIVETo determine risk factors for recurrence of CRE among presumed CRE-free patients.METHODSCase-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.RESULTSIncluded 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.CONCLUSIONSWe 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

scholarly journals Risk Factors for Postpartum Hemorrhage in a Thai–Myanmar Border Community Hospital: A Nested Case-Control Study

2021 ◽  
Vol 18 (9) ◽  
pp. 4633
Author(s):  
Waraporn Thepampan ◽  
Nuchsara Eungapithum ◽  
Krittai Tanasombatkul ◽  
Phichayut Phinyo
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Postpartum Hemorrhage ◽  
Minority Groups ◽  
Case Control Study ◽  
Community Hospital ◽  
Case Control ◽  
Border Community ◽  
Nested Case Control ◽  
Control Study

Postpartum hemorrhage (PPH) is a common complication of pregnancy and a global public health concern. Even though PPH risk factors were extensively studied and reported in literature, almost all studies were conducted in non-Asian countries or tertiary care centers. Our study aimed to explore relevant risk factors for PPH among pregnant women who underwent transvaginal delivery at a Thai–Myanmar border community hospital in Northern Thailand. An exploratory nested case-control study was conducted to explore risk factors for PPH. Women who delivered transvaginal births at Maesai hospital from 2014 to 2018 were included. Two PPH definitions were used, which were ≥ 500 mL and 1000 mL of estimated blood loss within 24 h after delivery. Multivariable conditional logistic regression was used to identify significant risk factors for PPH and severe PPH. Of 4774 women with vaginal births, there were 265 (5.55%) PPH cases. Eight factors were identified as independent predictors for PPH and severe PPH: elderly pregnancy, minority groups, nulliparous, previous PPH history, BMI ≥ 35 kg/m2, requiring manual removal of placenta, labor augmentation, and fetal weight > 4000 gm. Apart from clinical factors, particular attention should be given to pregnant women who were minority groups as PPH risk significantly increased in this population.

scholarly journals Risk factors for suicidal tendency in people with epilepsy in China: a case–control study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mintao Lin ◽  
Jiani Chen ◽  
Sisi Li ◽  
Yingjie Qin ◽  
Xuruan Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Low Income ◽  
Case Control Study ◽  
Univariate Analysis ◽  
Case Control ◽  
Conditional Inference ◽  
Suicidal Tendency ◽  
Patients With Epilepsy ◽  
Nested Case Control ◽  
Control Study

AbstractPeople with epilepsy (PWE) have an increased suicide prevalence. This study aimed to identify the risk factors for suicidal tendency among PWE in West China. A nested case–control study was designed in a cohort of patients with epilepsy (n = 2087). In total, 28 variates were calculated. In the univariate analysis, unemployment, low income, seizure frequency, seizure-free time, infectious or structural etiology, levetiracetam or phenobarbital use, anxiety, depression, and stigma were associated with suicidal tendency. A multivariate analysis indicated that unemployment (odds ratio [OR] 5.74, 95% confidence interval [CI] 2.13–15.48), levetiracetam use (OR 2.80, 95%CI 1.11–7.05), depression (C-NDDI-E score ≥ 13; OR 3.21, 95%CI 1.26–8.21), and stigma (SSCI score ≥ 16; OR 6.67, 95%CI 1.80–24.69) were independently associated with suicidal tendency. Conditional inference tree analysis indicated that SSCI and C-NDDI-E scores could effectively identify patients with suicidal tendency. Thus, this study suggests that unemployment, levetiracetam use, depression, and stigma are independent risk factors for suicidal tendency in PWE in China.

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