1174. Epidemiology of Carbapenem-Resistant Enterobacteriaceae, a 5-year Experience at a Tertiary Care Hospital
Session: Poster Abstract Session: Healthcare Epidemiology: MDR-Gram Negative Infections
Friday, October 5, 2018
Room: S Poster Hall
Background: Carbapenem-resistant Enterobacteriaceae (CRE) has been increasing worldwide. Our objectives were to study the epidemiology of CRE and compare risk factors and mortality of carbapenem non-susceptibility to ertapenem alone Enterobacteriaceae (NSEE) with non-susceptibility to other carbapenems (imipenem, meropenem, or doripenem) Enterobacteriaceae (NSOCE) at a tertiary care hospital in Thailand.

Methods: All CRE isolated from clinical and surveillance cultures were identified from 12/2011-12/2016. Quarterly incidence rate per 100,000 patient-days was estimated. Hospital-wide carbapenem consumption were calculated as defined daily doses (DDD) per 1,000 patient-days. Relationships between hospital-wide carbapenem consumption and incidence of CRE were tested using Poisson regression. Comparative analysis of factors associated with NSEE and NSOCE, and risk factors associated with 14- and 30-day mortality in patients with CRE infection was conducted in adult patients.

Results: The quarterly CRE incidence of unique patients increased significantly from 3.37 per 100,000 patient-days in the last quarter of 2011 to 32.49 per 100,000 patient-days in the last quarter of 2016. Quarterly CRE incidence increased 1.07 per 100,000 patient-days (95% confidence interval [CI], 0.49–1.06; P-value for trend <.001). Quarterly hospital-wide carbapenem consumption increased 1.58 DDD per 1,000 patient-days (95% CI, 0.56–2.59; P-value for trend =.004). The expected increase of CRE incidence was 1.02 per 100,000 patient-days for a one DDD per 1,000 patient-days increase in carbapenem consumption (95% CI, 1.01–1.03; P-value <.001). There were 40 patients with NSEE and 134 patients with NSOCE. In the multivariate analysis, lower carbapenem exposure was significantly associated with the NSEE group (adjusted odds ratio: 0.25; 95% CI, 0.11-0.56). No difference in 14-day and 30-day all-cause mortality between NSEE group and NSOCE group was observed.

Conclusion: The incidence of CRE has risen significantly over a 5-year period at our institution. The important risk factor for non-susceptibility to other carbapenems compared to non-susceptibility to ertapenem alone was previous carbapenem use. Our hospital-wide carbapenem use has significantly increased over time, and associated with the increasing incidence of CRE.

Darunee Chotiprasitsakul, MD, MPH1, Sirawat Srichatrapimuk, MD, PhD2, Suppachok Kirdlarp, MD1 and Pitak Santanirand, PhD3, (1)Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, (2)Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samutprakan, Thailand, (3)Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Disclosures:

D. Chotiprasitsakul, None

S. Srichatrapimuk, None

S. Kirdlarp, None

P. Santanirand, None

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