Infect Chemother.  2016 Sep;48(3):166-173. 10.3947/ic.2016.48.3.166.

Carbapenem-resistant Enterobacteriaceae: Prevalence and Risk Factors in a Single Community-Based Hospital in Korea

• Lee HJ
• Choi JK
• Cho SY
• Kim SH
• Park SH
• Choi SM
• Lee DG
• Choi JH
• Yoo JH

• KMID: 2466428
• DOI: http://doi.org/10.3947/ic.2016.48.3.166

Abstract

BACKGROUND
Carbapenemase-producing Enterobacteriaceae (CPE) are Gram-negative bacteria with increasing prevalence of infection worldwide. In Korea, 25 cases of CPE isolates were reported by the Korea Centers for Disease Control and Prevention in 2011. Most CPE cases were detected mainly at tertiary referral hospitals. We analyzed the prevalence and risk factors for carbapenem-resistant Enterobacteriaceae (CRE) in a mid-sized community-based hospital in Korea.
MATERIALS AND METHODS
We retrospectively analyzed all consecutive episodes of Enterobacteriaceae in a mid-sized community-based hospital from January 2013 to February 2014. CRE was defined as organisms of Enterobacteriaceae showing decreased susceptibility to carbapenems. Risk factors for CRE were evaluated by a case-double control design. Carbapenemase was confirmed for CRE using a combined disc test.
RESULTS
During 229,710 patient-days, 2,510 Enterobacteriaceae isolates were obtained. A total of 41 (1.6%) CRE isolates were enrolled in the study period. Thirteen species (31.7%) were Enterobacter aerogenes, 8 (19.5%) Klebsiella pneumoniae, 5 (12.2%) Enterobacter cloacae, and 15 other species of Enterobacteriaceae, respectively. Among the 41 isolates, only one (2.4%) E. aerogenes isolate belonged to CPE. For evaluation of risk factors, a total of 111 patients were enrolled and this included 37 patients in the CRE group, 37 in control group I (identical species), and 37 in control group II (different species). Based on multivariate analysis, regularly visiting the outpatient clinic was a risk factor for CRE acquisition in the control group I (P = 0.003), while vascular catheter and Charlson comorbidity index score ≥ 3 were risk factors in control group II (P = 0.010 and 0.011, each). Patients with CRE were more likely to experience a reduced level of consciousness, use a vasopressor, be under intensive care, and suffer from acute kidney injury. However, CRE was not an independent predictor of mortality compared with both control groups.
CONCLUSION
In conclusion, the prevalence of CRE was higher than expected in a mid-sized community-based hospital in Korea. CRE should be considered when patients have a vascular catheter, high comorbidity score, and regular visits to the outpatient clinic. This study suggests the need for appropriate prevention efforts and constant attention to CRE infection control in a mid-sized community-based hospital.

Keyword

Carbapenems; Enterobacteriaceae; Risk factors; Prevalence; Drug resistance

MeSH Terms

Acute Kidney Injury
Ambulatory Care Facilities
Carbapenems
Centers for Disease Control and Prevention (U.S.)
Comorbidity
Consciousness
Critical Care
Drug Resistance
Enterobacter aerogenes
Enterobacter cloacae
Enterobacteriaceae*
Gram-Negative Bacteria
Humans
Infection Control
Klebsiella pneumoniae
Korea*
Mortality
Multivariate Analysis
Prevalence*
Retrospective Studies
Risk Factors*
Tertiary Care Centers
Vascular Access Devices
Carbapenems

Figure

• 

  Figure 1 Number of species of carbapenem-resistant Enterobacteriaceae

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