1182. Risk factors for the acquisition of IMP-type carbapenemase-producing carbapenem-resistant Enterobacteriaceae in Japan: A matched case-control study
Session: Poster Abstract Session: Healthcare Epidemiology: MDR-Gram Negative Infections
Friday, October 5, 2018
Room: S Poster Hall
Background: The majority of CRE in Japan are IMP-type carbapenemase-producing CRE (IMP-CRE). However, research on risk factors for the acquisition of IMP-CRE has been limited, and questions exist regarding whether IMP-CRE have risk factors similar to other types of CRE such as KPC.

Methods: We conducted a matched case-control study involving patients from whom IMP-CRE had been isolated. The controls were selected among patients with carbapenem susceptible Enterobacteriaceae (CSE). Non–meropenem-susceptible per CLSI criteria and/or ceftazidime-resistant Enterobacteriaceae were screened, and metallo-beta-lactamase–positive isolates were examined for blaIMP by PCR (01/2012 –12/2016).

Results: Ninety-six patients with CRE were matched with 96 patients with CSE. They comprised Enterobacter sp. (n=132 [CRE: 66, CSE: 66], 68.8%) and Klebsiella pneumoniae (n=60 [CRE:30, CSE:30], 31.2%), and bacteria were most commonly isolated from sputum (n=76 [39.6%]), followed by urine (n=62 [32.3%]). Background factors such as age (median=75 [IQR: 66-84]), sex (male=56.8%), and the Charlson comorbidity index (median=2 [IQR: 1-3.8]) were similar between CRE and CSE. In multivariate analysis, independent risk factors were identified: history of gastrointestinal (GI) endoscopy or surgery, history of ICU stay, and a previous exposure within 1 month to penicillins with beta-lactamase inhibitors, cephalosporines, or carbapabnems.

Conclusion: Histories of GI endoscopy and ICU stay as well as broad-spectrum antimicrobial exposure were identified as risk factors for CRE isolation. Infection control measures combined with enhanced antimicrobial stewardship are key to preventing the spread of IMP-CRE.

Multivariate analysis of risk factors for isolation of IMP-CRE , n (%)






Adjusted odds ratio

(95% CI)


P value


GI endoscopy or surgery

28 (29)

12 (13)

3.03 (1.24-7.43)


ICU stay

32 (33)

18 (19)

2.25 (1.0-5.04)


Device use

Nasogastric tube

43 (45)

24 (25)

1.27 (0.58-2.78)


Urinary catheter

59 (61)

38 (40)

1.66 (0.83-3.33)



18 (19)

7 (7)

2.17 (0.71-6.59)


PEG tube

10 (10)

3 (3)

3.89 (0.74-20.57)


Antibiotic exposure ≤

1 month

Penicillins with beta-lactamase inhibitors

52 (54)

27 (28)

4.54 (2.17-9.49)



40 (42)

19 (20)

3.38 (1.54-7.43)



25 (26)

10 (10)

3.08 (1.24-7.66)


Sho Saito, MD1, Kayoko Hayakawa, MD, PhD1, Masahiro Ishikane, MD, PhD1, Taichi Tajima, RN2, Nobuaki Matsunaga, MD, PhD, MPH3, Satoshi Ide, MD1, Noriko Kinoshita, MD1, Yoshiki Kusama, MD2, Yumiko Fujitomo, MD, PhD2, Takato Nakamoto, MD1, Yuta Toda, MD1 and Norio Ohmagari, MD, MSc, PhD1, (1)Disease Control and Prevention Center, National Center for Global Health and Medicine (NCGM), Tokyo, Japan, (2)AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan, (3)AMR Clinical Reference Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan


S. Saito, None

K. Hayakawa, None

M. Ishikane, None

T. Tajima, None

N. Matsunaga, None

S. Ide, None

N. Kinoshita, None

Y. Kusama, None

Y. Fujitomo, None

T. Nakamoto, None

Y. Toda, None

N. Ohmagari, None

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