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.
S. Kirdlarp, None
P. Santanirand, None
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