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Mechanical ventilation, MDR organism carriage increases risk for CP-CRE transmission
Along with extended exposure, a recent study suggested that mechanical ventilation and carriage of a multidrug-resistant organism could increase an individual’s risk for person-to-person carbapenemase-producing, carbapenem-resistant Enterobacteriaceae, or CP-CRE, transmission.
“The spread of CP-CRE is a major public health concern because it is extremely drug- resistant; however, the research on these pathogens is very limited, and so is our knowledge on their transmission,” Vered Schechner, MD, infection control physician in the department of epidemiology at Tel Aviv Sourasky Medical Center, Israel, said in a press release. “Identifying high-risk groups helps us to avoid excessive screening that can be risky and expensive, and to determine who should be screened and who might be a candidate for pre-emptive isolation or antibiotics.”
To identify these CP-CRE risk factors, Schechner and colleagues enrolled a cohort of individuals who recently underwent rectal screening for CP-CRE after confirmed contact with a newly identified case at an Israeli tertiary care hospital. For each CP-CRE index patient, they matched one contact positive for new CP-CRE infection to two uninfected contacts. The researchers then compared and analyzed these matched patients to identify possible predictors of CP-CRE acquisition.
Among 319 investigations conducted between October 2008 and June 2012, the researchers selected 53 positive contacts and 106 negative contacts for the final analysis. The only carbapenemase identified in the positive contact and their corresponding index cases was blaKPC.
After adjustment, multivariate analysis including exposure to specific antibiotic classes revealed three independent risk factors for CP-CRE: mechanical ventilation (OR = 4.1; 95% CI, 1.4-11.9), carriage or infection with another multidrug-resistant (MDR) organism (OR = 2.6; 95% CI, 1-7.1) and a contact period of at least 3 days (OR = 9.8; 95% CI, 2-48.9). Further, they found receipt of carbapenems conferred a nonsignificant increase in acquisition risk (OR = 4; 95% CI, 0.8-19), while cephalosporin receipt was protective against CP-CRE acquisition (OR = 0.2; 95% CI, 0.1-0.6).
“Cohorting all CP-CRE carriers is a key component in controlling the spread of these [MDR organisms] in health care settings,” Schechner and colleagues wrote. “Relying solely on clinical cultures detects only a fraction of the actual colonized population. Therefore, active surveillance of high-risk patients, including patients in contact with an index case, is strongly recommended.” – by Dave Muoio
Disclosure: Schechner reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
