Journal of Korean Biological Nursing Science

Korean society of Biological Nursing Science (한국기초간호학회)
권호 표지
DOI QR코드

DOI QR Code

Risk factors for the colonization of carbapenem-resistant Enterobacteriaceae in patients transferred to a small/medium-size hospital in Korea: a retrospective study

중소병원으로 전원 온 환자의 카바페넴내성장내세균속균종 보균 위험요인

  • Misun Lee (Graduate School of Nursing Science, Hallym University) ;
  • Hyunjung Kim (School of Nursing, Research Institute of Nursing Science, Hallym University)
  • 이미선 (한림대학교 간호대학원) ;
  • 김현정 (한림대학교 간호대학, 간호학연구소)
  • Received : 2023.10.13
  • Accepted : 2023.11.12
  • Published : 2023.11.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This study aimed to identify the colonization rate of carbapenem-resistant Enterobacteriaceae (CRE), the characteristics of CRE isolates, and risk factors for CRE colonization in patients transferred to the general wards of a small/medium-sized hospital. Methods: This retrospective study was conducted on patients who underwent CRE culture tests within 24 hours of admission among patients transferred to a small/medium-sized hospital. Forty-seven patients confirmed as positive for CRE were classified as belonging to the patient group. For the control group, 235 patients (five times the number of the patient group) were matched by sex, age, and diagnosis, and then selected at random. Data were analyzed using descriptive analysis and multiple logistic regression analysis. Results: The CRE colonization rate was 5% (47 out of 933 patients), and Klebsiella pneumoniae (68.0%) was the most common isolate of CRE. The positivity rate of carbapenemase-producing Enterobacteriaceae was 61.7%. The risk factors for CRE colonization included renal disease (odds ratio [OR]=4.93; 95% confidence interval [CI], 1.49-16.31), heart disease (OR=3.86; 95% CI, 1.35-11.01), indwelling urinary catheters (OR=4.43; 95% CI, 1.59-12.36), and cephalosporin antibiotic use (OR=8.57; 95% CI, 1.23-59.60). Conclusion: Having a comorbid renal or cardiac disease, an indwelling urinary catheter, or a history of exposure to cephalosporin antibiotics could be classified as risk factors for CRE colonization in patients transferred to small and medium-size hospitals. It is necessary to perform active infection control through proactive CRE culture testing of patients with risk factors.

Keywords

References

  1. Korea Ministry of Government Legislation. Law on the prevention and management of infectious diseases [Internet]. Sejong: Korea Ministry of Government Legislation [cited 2022 Dec 13]. Available from: https://www.law.go.kr/LSW/conAdmrulByLsPop.do?&lsiSeq= 242981&joNo = 0002
  2. Joo SJ, Kim MK, Shin EK, Yoo JI. Molecular characteristic analysis and antimicrobial resistance of carbapenem-resistant Enterobacteriaceae (CRE) isolates in the Republic of Korea, 2017-2020. Cheongju: Korea Centers for Disease Control and Prevention; 2021 [cited 2022 Mar 05]. Available from: https://kdca.go.kr/filepath/boardSyview.es?bid =0034&list_no =718129&seq=1
  3. Lee YJ, Kang JE, Ham JY, Lee JG. Risk factors of carbapenem-resistant Enterobacteriaceae acquisition at a community-based hospital. Korean Journal of Clinical Pharmacy. 2020; 30(2):120-126. https://doi.org/10.24304/kjcp.2020.30.2.120
  4. Tacconelli E, Carrara E, Savoldi A, Harbarth S, Mendelson M, Monnet DL, et al. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. The Lancet Infectious Diseases. 2018;18(3):318-327. https://doi.org/10.1016/S1473-3099(17)30753-3
  5. Korea Centers for Disease Control and Prevention. Infection diseases surveillance yearbook, 2020 [Internet]. Cheongju: Korea Centers for Disease Control and Prevention; 2021 [cited 2022 Oct 03]. Available from: https://npt.kdca.go.kr/npt/biz/npp/portal/nppPblctDtaView.do?pblctDtaSe At = 1&pblctDtaSn= 2452
  6. Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2019. Atlanta: Centers for Disease Control and Prevention; 2019.
  7. Centers for Disease Control and Prevention. Facility guidance for control of carbapenem resistant Enterobacteriaceae (CRE) [Internet]. Atlanta: Centers for Disease Control and Prevention; 2015 [cited 2022 May 05]. Available from: https://www.cdc.gov/hai/pdfs/cre/cre-guidance-508.pdf
  8. Tischendorf J, Avila RA, Safdar N. Risk of infection following colonization with carbapenem-resistant Enterobacteriaceae: a systematic review. American Journal of Infection Control. 2016;44(5):539-543. https://doi.org/10.1016/j.ajic.2015.12.005
  9. Ling ML, Tee YM, Tan SG, Amin IM, How KB, Tan KY, et al. Risk factors for acquisition of carbapenem resistant Enterobacteriaceae in an acute tertiary care hospital in Singapore. Antimicrobial Resistance & Infection Control. 2015;4(1):1-7. https://doi.org/10.1186/s13756-015-0066-3
  10. Martin ET, Tansek R, Collins V, Hayakawa K, Abreu-Lanfranco O, Chopra T, et al. The carbapenem-resistant Enterobacteriaceae score: a bedside score to rule out infection with carbapenem-resistant Enterobacteriaceae among hospitalized patients. American Journal of Infection Control. 2013; 41(2):180-182. https://doi.org/10.1016/j.ajic.2012.02.036
  11. Song JY, Jeong IS. Development of a risk prediction model of carbapenem-resistant Enterobacteriaceae colonization among patients in intensive are units. American Journal of Infection Control. 2018;46(11):1240-1244. https://doi.org/10.1016/j.ajic.2018.05.001
  12. Korea Centers for Disease Control and Prevention. Healthcare-associated infectious disease control guidelines [Internet]. Cheongju: Korea Centers for Disease Control and Prevention; 2021 March 26 [cited 2021 Dec 01]. Available from: https://kdca.go.kr/filepath/ boardSyview.es?bid= 0019&list_no= 712842&seq= 1
  13. Kang JS, Yi JY, 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. Journal of Korean Medical Science. 2019;34(18):1-11. https://doi.org/10.3346/jkms.2019.34.e140
  14. Park JK, Kim YH, Jung JS, Jung JW. Prevalence and risk factors of carbapenem-resistant Enterobacteriaceae (CRE) colonization at the time of admission in hospital wards. Korean Society of Nursing Science cademic conference; 2020. p. 220.
  15. Seo SM, Jeong IS. External validation of carbapenem-resistant Enterobacteriaceae acquisition risk prediction model in a medium sized hospital. Journal of Korean Academy of Nursing. 2020;50(4):621-630. https://doi.org/10.4040/jkan.20137
  16. Public data portal. National Medical Institution Status [Internet]. Sejong: Ministry of the Interior and Safety; 2022 [cited 2022 Dec 13]. Available from: https://www.data.go.kr/data/15096293/standard.do
  17. Park HJ, Koo HS, Lee SJ, Lee HM, Jeong YW. Status of healthcare-associated infection control by type of healthcare facilities in 2018. Korea Centers for Disease Control and Prevention. Weekly Health and Illness. 2018;12(31):1054-1061.
  18. Park WW, Son SY, Park HS, Park HS. A proposal on determining appropriate sample size considering statistical conclusion validity. Seoul Journal of Industrial Relations. 2010;21:51-85.
  19. Lee HJ, Choi JK, Cho SY, Kim SH, Park SH, Choi SM, et al. Carbapenem-resistant Enterobacteriaceae: prevalence and risk factors in a single community-based hospital in Korea. Infection & Chemotherapy. 2016;48(3):166-173. https://doi.org/10.3947/ic.2016.48.3.166
  20. Schechner V, Kotlovsky T, Kazma M, Mishali H, Schwartz D, Navon-Venezia S, et al. Asymptomatic rectal carriage of blaKPC producing carbapenem-resistant Enterobacteriaceae: who is prone to become clinically infected? Clinical Microbiology and Infection. 2013;19(5):451-456. https://doi.org/10.1111/j.1469-0691.2012.03888.x
  21. Bhargava A, Hayakawa K, Silverman E, Haider S, Alluri KC, Datla S, et al. Risk factors for colonization due to carbapenem-resistant Enterobacteriaceae among patients: exposed to long-term acute care and acute care facilities. Infection Control & Hospital Epidemiology. 2014;35(4):398-405. https://doi.org/10.1086/675614
  22. Lee EJ, Lee SJ, Park HJ, Kim SN, Lee HM. Analysis of carbapenemase-producing Enterobacteriaceae (CPE) surveillance results for 2017 in Korea: comparison with the surveillance results of the previous 5 years (2012-2016). Korea Centers for Disease Control and Prevention. Weekly Health and Illness. 2018;11(47):1586-1619.
  23. Kofteridis DP, Valachis A, Dimopoulou D, Maraki S, Christidou A, Mantadakis E, et al. Risk factors for carbapenem-resistant Klebsiella pneumoniae infection/colonization: a casecase-control study. Journal of Infection and Chemotherapy,. 2014;20(5):293-297. https://doi.org/10.1016/j.jiac.2013.11.007
  24. Gao Y, Chen M, Cai M, Liu K, Wang Y, Zhou C, et al. An analysis of risk factors for carbapenem-resistant Enterobacteriaceae infection. Journal of Global Antimicrobial Resistance. 2022;30:191-198. https://doi.org/10.1016/j.jgar.2022.04.005
  25. de Maio Carrilho C, de Oliveira LM, Gaudereto J, Perozin JS, Urbano MR, Camargo CH, et al. A prospective study of treatment of carbapenem-resistant Enterobacteriaceae infections and risk factors associated with outcome. BMC Infectious Diseases. 2016;16(1):1-9. https://doi.org/10.1186/s12879-016-1979-z
  26. Ministry of Health and Welfare. Regional Cardiocerebrovascular Disease Center 2020 Operational Guidelines [Internet]. Sejong: Ministry of Health and Welfare; 2020 [cited 2022 Dec 01]. Available from: https://www.mohw.go.kr/board.es?mid=a10411010300&bid=0019&act=view&list_no= 365757
  27. The Korean Society of Heart Failure. 2022 Guideline for the Management of Heart failure. Seoul: The Korean Society of Heart Failure; 2022. p. 1-277.
  28. Korea Centers for Disease Control and Prevention. Promotion of catheter associated urinary tract infection (CAUTI) prevention [Internet]. Cheongju: Korea Centers for Disease Control and Prevention; 2019 [cited 2022 Oct 3]. Available from: https://library.nih.go.kr/ncmiklib/synap/skin/doc.html?fn=6e163e5f4a603b5457d3303139c8cf26b3987bca36ce008e0f17a39b68ee5623&rs=/roms/ncmik/st1/synap/202311&fileKey=86648
  29. Park CE. Evaluation of the effectiveness of surveillance on improving the detection of healthcare associated infections. Korean Journal of Clinical Laboratory Science. 2019;51 (1):15-25. https://doi.org/10.15324/kjcls.2019.51.1.15
  30. Korea Centers for Disease Control and Prevention. Clinical practice guidelines for urinary tract infections [Internet]. Cheongju: Korea Centers for Disease Control and Prevention; 2017 [cited 2022 Oct 3]. Available from: https://library.nih.go.kr/ncmiklib/synap/skin/doc.html?fn =802750d8d4d885cdb120bc298d03f173903e37e163d51a2014044608a8ff682a&rs=/ncmiklib/ncmik/st1/synap/202306&-fileKey=76536
  31. Wu D, Cai J, Liu J. Risk factors for the acquisition of nosocomial infection with carbapenem-resistant Klebsiella pneumoniae. Southern Medical Journal. 2011;104(2):106-110. https://doi.org/10.1097/SMJ.0b013e318206063d
  32. Satlin MJ, Cohen N, Ma KC, Gedrimaite Z, Soave R, Askin G. Bacteremia due to carbapenem-resistant Enterobacteriaceae in neutropenic patients with hematologic malignancies. Journal of Infection. 2016;73(4):336-345. https://doi.org/10.1016/j.jinf.2016.07.002
  33. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA, Healthcare Infection Control Practices Advisory Committee. Guideline for prevention of catheter-associated urinary tract infections 2009. Infection Control & Hospital Epidemiology. 2010;31(4):319-326. https://doi.org/10.1086/651091
  34. Choi EY, Song MS. Factors influencing the infection control performance of catheter-associated urinary tract infection of nurses in hospitals. Journal of Korean Clinical Nursing Research. 2019;25(3):303-313. https://doi.org/10.22650/JKCNR.2019.25.3.303