Background: Carbapenem-resistant Enterobacteriaceae (CRE) infections have become endemic to the United States since their first appearance almost a decade ago. At the University of Illinois Hospital and Health Sciences System, over 110 patients have been diagnosed with evidence of colonization, infection or both since 2008. As CRE infections are known to have high mortality, it is important to gain further knowledge on potential risk factors for outcomes.
Methods: Cultures positive for CRE from from January 1, 2008 to March 31, 2013. were identified by retrospectively using a clinical microbiology laboratory database. Clinical records were reviewed for co-morbid conditions and death. For cases designated as colonization, subsequent admissions were evaluated to determine if they developed CRE infection and to identify any potential risk factors associated with infection.
Results: 138 CRE isolates were identified during the study period. These reflected 110 patients, 21 of whom had duplicate isolates. There were 57 males and 53 females with an average age of 54.82 years (range 1.5 to 89 years). The majority of cases were admitted from home (85 cases, 61.6%), with remaining (39.1%) admitted from another health care setting. However, 126 cases had a history of a prior hospitalization, 59% occurring within 30 days prior to index admission. End stage renal disease, Diabetes and organ transplantation were the most common associated co-morbidities. Klebsiella pneumonia accounted for 90% of CRE isolates and all isolates were KPC-producing Enterobacteriaceae. CRE isolates were most commonly found in urine samples. 20 patients died during index admission. 65% of deaths occurred between 2008 - 2010. 34 cases (27%) had a readmission while 73 (58%) were not readmitted and considered to have recovered from CRE infection. Figure 1 shows a trend over time toward improved survival.
Conclusion: CRE infections remain a serious issue for patients with renal disease and organ transplantation at our institution. However, improved identification of this infection may be leading to improved patient outcomes.
M. K. Sikka, None
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