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Former CRE carriers require extended screening to limit recurrence risk
Carbapenem-resistant enterobacteriaceae carrier status should be upheld for a minimum of 1 year after the last positive sample due to possible recurrence of the bacterium, recent data suggest.
Researchers evaluated 276 previous carriers of CRE treated at Rambam Health Care Campus, a 940-bed teaching hospital in Haifa, Israel. All patients appeared CRE-free at study inception, after at least two separate screenings.
The case group included patients with recurrence of CRE carriage; control patients showed no recurrence. CRE recurrence in all ensuing admissions to Israeli health care facilities was identified through clinical samples and repeated rectal screenings. The patients with recurrence were compared with controls, and surviving patients were followed for 1 year.
Recurrence occurred in 13% of patients within 1 year after apparent CRE elimination. Factors significantly correlated with CRE recurrence included time between the last positive CRE sample and presumed CRE elimination (OR = 0.94; 95% CI, 0.89-0.99 per month), the existence of foreign bodies at apparent CRE elimination (OR = 4.6; 95% CI, 1.64-12.85) and repeat admissions during follow-up (OR = 3.15; 95% CI, 1.05-9.47).
Patients whose CRE carrier status presumably was eradicated 6 months after the last known CRE-positive sample had a recurrence rate of 25% vs. 7.5% among patients presumed to be CRE-free after 1 year.
According to the researchers, these findings may suggest a need to revise current guidelines for CRE-carrier designation.
“Drawing from our study, some suggestions for assessment of patients for CRE eradication can be derived because we showed a significant rate of CRE recurrence after presumed eradication,” the researchers wrote. “We suggest that the CRE-carrier status be maintained for at least 1 year following the last known positive CRE sample, especially for patients with foreign bodies.” – by Jen Byrne
Disclosure: The researchers report no relevant financial disclosures.