Risk factors of carbapenemase-producing Enterobacterales acquisition among adult intensive care unit patients at a Kentucky Academic Medical Center

Abstract

Summary: Background: Acquisition of carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) are associated with negative health outcomes. Our adult intensive care unit (ICU) population has experienced low levels of CP-CRE acquisition; however, specific risk factors for this population at our medical facility have not been studied. Aims: To identify risk factors of CP-CRE acquisition and describe CP-CRE epidemiology among adult ICU patients at our medical facility. Methods: A retrospective cohort study was performed at a Kentucky Academic Medical Center. Surveillance specimens were collected at admission and weekly thereafter to identify CP-CRE colonization. Clinical data were extracted from patient medical records. Cases were defined as those who tested positive for CP-CRE on ICU admission day 3 or greater. Risk of CP-CRE acquisition was calculated using Modified Poisson regression. Findings: Independent risk factors of CP-CRE acquisition included administration of enteral tube feeds (risk ratio [RR], 4.46; 95% confidence interval [CI], 1.74–11.43); diagnosis of Clostridioides difficile enterocolitis (RR, 3.51; 95% CI, 1.27–9.68), pressure ulcer (RR, 3.48; 95% CI, 1.91–6.36), and morbid obesity (RR, 2.10; 95% CI, 1.12–3.95); having a drainage tube (RR, 2.63; 95% CI, 1.38–4.98); admission to a medical ICU (RR, 2.39; 95% CI, 1.32–4.35); 90-day use of a carbapenem (RR, 2.27; 95% CI, 1.21–4.26); and dialysis procedure (RR, 2.22; 95% CI, 1.15–4.27). Conclusion: Most CP-CRE risk factors were associated with alteration of colon microbiota and/or invasive procedures/devices. These results will assist in creating a more targeted CP-CRE active surveillance system and highlight areas for infection prevention intervention.

Keywords

• CRE
• MDRO
• ICU
• Carbapenem
• Carbapenemase