Risk Factors for Vancomycin-resistant Enterococci and Carbapenemase-producing Carbapenem-resistant Enterobacteriaceae Colonization at admission to a Tertiary-care Center
Vancomycin-resistant Enteroccocus (VRE) and Carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) infections are rapidly emerging in Singapore. Colonization often precedes infection. But, prevalence and factors associated with VRE and CP-CRE colonization remain unknown.
Our study aims to determine the prevalence of VRE and CP-CRE colonization at admission and factors associated with colonization in an adult tertiary-care center in Singapore.
All new admissions (<48 hours) to 1600 bed Tan Tock Seng Hospital, Nov 3-7 2013, were screened for VRE and CP-CRE via rectal swabs using selective culture media. A multiplex PCR with primers targeting blaNDM, blaKPC, blaOXA-48-like, blaIMP and blaIMI was done on meropenem non-susceptible Enterobacteriaceae isolates. Clinical data was obtained from medical records. VRE and CP-CRE colonizers were compared with non-colonizers in case-control studies. To compare differences in covariates between groups, odds ratios and 95% confidence intervals were computed. Multiple logistic regression models were constructed to control for confounding and determine independent factors.
Of 684 patients screened, 13 (1.9%) were colonized with VRE (8 Van A and 5 Van B) and 5 (0.7%) with CP-CRE (2 NDM, 1 KPC, 1 IMP, 1 IMI). Compared to non-colonizers, VRE-colonizers were more likely to have been hospitalized locally in the past 1 year (OR 17.71, 95%CI 2.14-146.68) and exposed to indwelling devices (OR 10.21, 95%CI 2.03-51.31). There was no difference in age, gender, comorbidity, and prior hospitalization overseas. After adjusting for age, gender, and comorbidity, exposure to indwelling devices (Adj OR 9.60, 95%CI 1.45-63.53) was independently associated with VRE colonization. In contrast, CP-CRE colonizers were more likely than non-colonizers to have had a past infection with a multidrug-resistant organism (MDRO) (OR 18.00, 95%CI 2.30-141.17). After adjusting for age, gender, and comorbidity, past MDRO infection (Adj OR 14.20, 95%CI 1.68-119.76) was significantly associated with CP-CRE colonization.
The prevalence of VRE and CP-CRE colonization at admission was low. Prior exposure to indwelling devices was associated with VRE colonization whilst past MDRO infection with CP-CRE colonization. Patients with such exposures should be actively screened at admission.
B. F. Poh, None
N. N. Win, None
J. Q. Kum, None
B. Ang, None
See more of: Poster Abstract Session