379. Risk Factors Associated with Isolation of Carbapenem Resistant Enterobacter sp. or Klebsiella sp. in Stool or Rectal Swab Surveillance Cultures Using a Matched Case-Control Sample of Patients Hospitalized between 2013-2015 Across a Large Integrated Healthcare System
Session: Poster Abstract Session: HAI: MDRO-GNR/Emerging Resistant Bacterial Pathogens
Thursday, October 5, 2017
Room: Poster Hall CD
Posters
  • 379_IDWPOSTER.pdf (343.7 kB)
  • Background: The incidence of Carbapenem resistant Enterobacteriaceae (CRE) organisms in healthcare facilities is rising. Active surveillance has been proposed as part of CRE prevention strategies in outbreak or high-risk settings to identify colonized patients that may serve as a reservoir for transmission. However, the optimal strategy for surveillance remains unclear. Identifying the risk factors associated with CRE colonization is critical to help target surveillance strategies.

    Methods: Active surveillance utilizing rectal cultures was performed August 2013 thru July 2015 with rotating point prevalences on 2-3 units per week in a large tertiary care hospital. 275 patients with Enterobacter sp. or Klebsiella sp. resistant or intermediate to one or more carbapenems isolated from rectal cultures were matched 1:1 with 275 patients of the same Charlson comorbidity score whose rectal surveillance cultures were negative. Univariate and multivariate were used to assess risk factors for CRE colonization

    Results: After controlling for patient age, chronic conditions, ICU stay, prior hospitalizations, multiple procedures, and antimicrobial exposures, the risk of having a CRE organism isolated by culture was 5% (95% CI ;1.03-1.08) greater for each additional inpatient admission the patient had in the 36 months prior to identification of CRE. Having a history of liver disease increased the risk of being colonized with CRE by 35% (95% CI; 1.01-1.80). The total number of antimicrobial exposures (orders) given in the prior 12 months increased the risk of having CRE by 1% (95% CI 1.00-1.01)for each additional exposure. Results:

    Conclusion: Having a history of liver disease, frequent antimicrobial exposures, or more frequent inpatient admissions are risk factors for colonization with CRE. Knowing a patient’s hospitalization and antimicrobial history in addition to health history may inform CRE surveillance strategies.

    Monica Schmidt, MPH, PhD, Center for Outcomes Research and Evaluation, Carolinas Healthcare System, Charlotte, NC, Melanie D. Spencer, PhD, MBA, Research, Dickson Advanced Analytics, Carolinas Healthcare System, Charlotte, NC and Catherine Passaretti, MD, Medicine, Atrium Health, Charlotte, NC

    Disclosures:

    M. Schmidt, None

    M. D. Spencer, None

    C. Passaretti, None

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