Highlights
- •576 patients with urine or sterile site cultures positive for CRE were evaluated.
- •Risk factors for positive urine and sterile site cultures were compared.
- •Invasive devices and recent surgery associated with positive sterile site cultures.
- •Focusing on indwelling device care and removal may decrease CRE infection risk.
Background
Invasive infections caused by carbapenem-resistant Enterobacterales (CRE) are of significant
concern in health care settings. We assessed risk factors for a positive CRE culture
from a sterile site (invasive infection) compared to isolation from urine in a large
patient cohort in Atlanta from August 2011 to December 2015.
Methods
CRE cases required isolation, from urine or a normally-sterile site, of E. coli, Klebsiella spp., or Enterobacter spp. that were carbapenem-nonsusceptible (excluding ertapenem) and resistant to all third-generation
cephalosporins tested. Risk factors were compared between patients with invasive and
urinary infections using multivariable logistic regression.
Results
A total of 576 patients had at least 1 incident case of CRE, with 91 (16%) having
an invasive infection. In multivariable analysis, the presence of a central venous
catheter (OR 3.58; 95% CI: 2.06-6.23) or other indwelling device (OR 2.34; 95% CI:
1.35-4.06), and recent surgery within the last year (OR 1.81; 95% CI: 1.08-3.05) were
associated with invasive infection when compared to urinary infection.
Discussion
Health care exposures and devices were associated with invasive infections in patients
with CRE, suggesting that targeting indwelling catheters, including preventing unwarranted
insertion or encouraging rapid removal, may be a potential infection control intervention.
Conclusions
Future infection prevention efforts to decrease CRE cases in health care settings
should focus on minimizing unnecessary devices.
Key Words
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Article Info
Publication History
Published online: December 24, 2021
Footnotes
Previous presentation: The research presented in this manuscript was presented as a poster abstract at the Society for Hospital Epidemiology conference in Atlanta, GA (May 18-21, 2016). Parts of this data were also included in a master's thesis that is indexed to Proquest.
Funding/support: This work was supported by a cooperative agreement with the Centers for Disease Control and Prevention's Emerging Infections Program ( U50CK000485 ). MES received support for this research and related coursework from the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR000454 .
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Conflicts of interest: None to report.
Identification
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© 2022 Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.
