345. Colonization with Carbapenem-Resistant Enterobacteriaceae (CRE) Increases the Risk of Bloodstream Infections with CRE
Session: Poster Abstract Session: HAI: Multi Drug Resistant Gram Negatives
Thursday, October 27, 2016
Room: Poster Hall
  • CRE_IDW16_poster.pdf (618.1 kB)
  • Background: Infections with carbapenem-resistant Enterobacteriaceae (CRE) carry high mortality rates. Identification of risk factors for development of infections may aid in rapid initiation of optimal antibiotic therapy. We aimed to determine if colonization with CRE detected through active surveillance cultures had an impact on the development of CRE bloodstream infections (BSI).

    Methods: Retrospective cohort study conducted at a 1500-bed county teaching hospital located in Miami, Florida, from August 2013 to August 2015. We included all patients consecutively admitted to the surgical intensive care unit (SICU) that had at least one surveillance culture done. Patients with evidence of CRE BSI prior to performance of first surveillance culture were excluded. Rectal and tracheal aspirate (if intubated) cultures were performed upon admission to the unit and weekly thereafter. Swabs were streaked on MacConkey agar plates containing 10 ug ertapenem disc and 10 ug meropenem discs and incubated overnight at 37°C. Colonies were then selected based on color and morphology. Final identification and susceptibilities were performed using Vitek II.The main outcome of interest was CRE BSI during index hospitalization. Relative risks and 95% confidence intervals (CI) were determined.

    Results: 1581 patients were included in the analysis, and 58 (3.7%) had CRE on surveillance cultures. 10 patients developed CRE BSI, out of which 4(40%) had evidence of CRE colonization prior to BSI. The risk of CRE BSI among surveillance positive patients was 6.89% (4/58). The risk of CRE BSI among surveillance negative patients was 0.39% (6/1523). The relative risk for the development of CRE BSI among surveillance positive patients compared to surveillance negative patients was 17.5 (95% CI: 5.1-60.3; p-value<0.0001).

    Conclusion: CRE colonization is a strong risk factor for the subsequent development of CRE BSI.

    Rossana Rosa, MD, Department of Medicine, Jackson Memorial Hospital-University of Miami Miller School of Medicine, Miami, FL, Jose Castro, MD, FIDSA, Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, Dennise Depascale, MT, Infection Control, Jackson Memorial Hospital, Miami, FL, Adriana Jimenez, MPH, MLS (ASCP), CIC., Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University., Miami, FL and L. Silvia Munoz-Price, MD, PhD, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI


    R. Rosa, None

    J. Castro, None

    D. Depascale, None

    A. Jimenez, None

    L. S. Munoz-Price, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.