Epidemiology of Carbapenem-Resistant Enterobacteriaceae (CRE) at an Academic Medical Center
Methods: A retrospective cohort study was conducted of all patients (pts) with a positive clinical culture for CRE from 1/2006 - 12/2013. Data was obtained from chart review. Cultures were categorized as infection or colonization (treated vs. not treated by the clinician).
Results: 46 pts had a positive culture for CRE and the rate per 1000 pt days significantly increased over the study (0.0063 in 2006 vs. 0.036 in 2013, p<0.001). Median (med) age was 59, 50% were male, 52% were Caucasian. Med Charlson Comorbidity Index was 5, med number of comorbidities was 3 (hypertension 63%, diabetes 46%, malignancy 20%) and 18 (42%) were receiving immunosuppression. 21 (54%) had antibiotic use within the past 6 months, most commonly a carbapenem (43%), followed by piperacillin/tazobactam (33%) and a cephalosporin (29%). Most (85%) had a history of another multi-drug resistant organism (MDRO), usually VRE or MRSA. 30 (75%) pts had CRE infection. Among these, the urinary tract accounted for 14 (47%), bloodstream for 6 (20%), respiratory tract for 6 (20%), and deep tissue for 4 (13%). Among pts with colonization, urine was the source in 7 (70%) and respiratory in 2 (20%). Overall, Klebsiella (54%) was the most common species followed by Enterobacter (26%), Escherichia coli (11%), Serratia (7%), and Citrobacter (2%). Med hospital stay was 39 days and med time to positive CRE culture was 16 days. 52% stayed in the ICU a med of 24 days. Overall hospital mortality was 17% (10% in colonized vs. 25% in infected pts) but 95% of infected pts experienced morbidity (www.cdc.gov/nchs/data/ice/ice95v1/c28.pdf). Among infected pts who died (6), 3 had urine, 2 had respiratory and 1 had blood as the source of infection. All were treated with appropriate antibiotics.
Conclusion: CRE rates increased at our Southeastern academic hospital. Advanced comorbidity index, history of previous MDRO, lengthy hospital stay and receipt of immunosuppression or broad spectrum antibiotics were common characteristics among pts with CRE. Pts with CRE infection suffered increased morbidity and mortality.
C. Salgado, Wolters Kluwer Health: Editorial Assistance, Licensing agreement or royalty
L. Richey, None
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