381. Risk Factors Associated with Carbapenem Resistant Enterobacter sp. or Klebsiella sp. Infection Using a Matched Case-Control Sample of Patients Hospitalized between 2010-2016 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
  • 381_IDWPOSTER.pdf (321.3 kB)
  • Background: The incidence of Carbapenem resistant Enterobacteriaceae (CRE) infections in healthcare facilities is rising. Infection with CRE has been associated with high mortality. Identifying risk factors associated with CRE infection is important to determine who may require closer monitoring at admission and to help guide empiric antibiotic selection.


    Cultures with Klebsiella sp and Enterobacter sp were collected between Jan 2010 and May 2016 from blood, surgical and sterile wound cultures. CRE infections were identified in 179 patients who were matched 1:1 with 179 patients with carbapenem sensitive Enterobacteriaceae (CSE) based on age, gender, race, Charlson comorbidity index, culture source and organism to. Risk factors were selected based on literature review. Univariate and multivariable incident risk ratios were calculated using a Poisson model that adjused for multiple chronic conditions and procedures such as endoscopy, colonoscopy and abdominal surgery.


    Adjusted analysis comparing matched CRE and CSE patients revealed that each additional round of antimicrobials received in the 12 months prior to culture was associated with a 2% increase risk of CRE infection (p<0.001). Patients with CRE infection were also 36% more likely than CSE patients to have undergone hemodialysis in the 12 months prior to admission, even after adjusting for chronic kidney disease. (p=0.05)


    Antimicrobial utilization and hemodialysis were associated with greater risk for CRE infection in our study. Judicious use of antimicrobials and closer monitoring of dialysis patients for early signs of infection may be warranted based on these results.

    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


    M. Schmidt, None

    M. D. Spencer, None

    C. Passaretti, None

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