1093. Carbapenem-resistant Enterobacteriaceae: Epidemiology of Infection and Colonization at a Brazilian University Hospital
Session: Poster Abstract Session: Surveillance of HAIs: Implementation and National Perspectives
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • jamile.pdf (690.4 kB)
  • Background: Enterobacteriaceae are microorganisms (MO) of importance in multiple scenarios and known for its development of resistance to many drugs, especially in a hospital environment. In 2001, Yigit et al. first described an enzyme capable of hydrolyzing carbapenems in Klebsiella pneumonia estrains and in 2009 there was the first report of a similar enzyme in Brazil by Monteiro and cols.

    Methods: A retrospective study was carried out by surveying database of Infection Control Commission (HICC), University Hospital of Londrina. All positive carbapenem-resistant Enterobacteriaceae (CRE) cultures were selected from Feb 2009 to Dec 2012, i.e. since CRE was detected in our hospital. Duplicated samples were excluded but those reflecting distinct sites were maintained. IBM ® SPSS Statistics v20 was used.

    Results: A total of 1312 cultures out of 1084 patients were analyzed. A population analysis revealed an average age of 57.5 years old and a predominance of males: 62%. Clinical infection totaled 34% of patients, being the remaining only colonized by CRE. The average time elapsed from hospital admission to the first sample with ERC growth was 18.8 days and the mean of hospital stay was 38.4 days.

    K. pneumoniae predominated, followed by Enterobacter species. We could notice the trend of spread of carbapenem-resistance among other Enterobacteriacea especies. The global death rate among colonized patients is 44.6%, and among infected ones is 57.6%. There was no temporary correlation between the density of incidence and mortality rates, neither in infected or colonized, nor on the ward or ICU. Table shows death rate per group. As described in the literature, urinary tract infection predominated among patients admitted to the wards, while pulmonary infections prevailed among the ICU, justifying the greater severity of patients.

     

    Group

    % (n)

    Death rate % (n)

    p

    Ward

    Infected

    34.3 (248)

    44.8 (111)

    0.001

    Colonized

    65.7 (475)

    32.2 (153)

    ICU

    Infected

    33.6 (198)

    73.7 (146)

    0.001

    Colonized

    66.4 (391)

    59.6 (233)

    Conclusion: Despite the efforts made regarding contact precautions and hand hygiene, the eradication has not been accomplished, and CRE has spread endemically in all our wards. That means our tertiary public teaching hospital has passed through innumerous experiences and is opened for discussion about detection and treatment of these MO.

    Cláudia Carrilho, MD1, Marsileni Pelisson, MDPharm2, Joseani Garcia3, Eliana Vespero3, Renata Belei3, José Carlos Dalmas4 and Jamile Perozin3, (1)State University of Londrina, Londrina-PR, Brazil, (2)Clinical Analyses, State University of Londrina, Londrina-PR, Brazil, (3)State University of Londrina, Londrina, Brazil, (4)Statistics, State University of Londrina, Londrina, Brazil

    Disclosures:

    C. Carrilho, None

    M. Pelisson, None

    J. Garcia, None

    E. Vespero, None

    R. Belei, None

    J. C. Dalmas, None

    J. Perozin, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.