University of Texas Health Science Center, San Antonio, TX, USA.
Ann Pharmacother. 2013 Sep;47(9):1115-21. doi: 10.1177/1060028013503120.
The occurrence of carbapenem-resistant Enterobacteriaceae (CRE) has been increasing at an alarming rate worldwide. Despite that increase, there are limited data identifying risk factors.
To evaluate risk factors associated with the acquisition of CRE among hospitalized patients.
We performed a retrospective case-case-control study in 4 community hospitals from June 2007 through June 2012. Case group 1 (CG1) consisted of patients with CRE. Case group 2 (CG2) consisted of patients with carbapenem susceptible Enterobacteriaceae (CSE). CG2 patients were matched to CG1 patients by site of infection and species of Enterobacteriaceae. Hospitalized controls were matched 2:1 by date of admission and hospital location to patients in CG1. Two sets of analyses were conducted comparing demographics, comorbidities, and antibiotic exposures of CG1 and CG2 to controls and then contrasted to identify unique risk factors associated with CRE.
Overall, 104 patients (CG1, 25 patients; CG2, 29 patients, control, 50 patients) were evaluated. CRE and CSE consisted mostly of Klebsiella spp. (63%) from a urinary source (28%). In multivariable analyses, intensive care unit (ICU) stay (OR 12.48; 95% CI 1.14-136.62; p = 0.04) and cumulative number of antibiotic days (OR 1.47; 95% CI 1.02-2.16; p = 0.04) were distinct independent predictors of CRE isolation; whereas, cumulative health care exposures (OR 2.03; 95% CI 1.20-3.41; p < 0.01) and vancomycin exposure (OR 6.70; 95% CI 1.15- 38.91; p = 0.03) were predictors for CSE.
CRE should be considered in patients requiring ICU admission, particularly those who have received multiple antibiotics. Antibiotic stewardship efforts should be directed at reducing all antibiotic exposures as opposed to any specific antibiotic class to reduce the risk of CRE.
碳青霉烯类耐药肠杆菌科（CRE）的发生在全球范围内以惊人的速度增加。尽管这种增加，但是确定危险因素的相关数据有限。
评估住院患者获得 CRE 的相关危险因素。
我们在 2007 年 6 月至 2012 年 6 月期间在 4 家社区医院进行了回顾性病例对照研究。病例组 1（CG1）由 CRE 患者组成。病例组 2（CG2）由对碳青霉烯类敏感的肠杆菌科患者组成。CG2 患者通过感染部位和肠杆菌科的种类与 CG1 患者相匹配。住院对照患者通过入院日期和医院位置与 CG1 患者 2:1 配对。比较 CG1 和 CG2 与对照患者的人口统计学、合并症和抗生素暴露情况，然后进行对比分析，以确定与 CRE 相关的独特危险因素。
总体而言，共有 104 名患者（CG1：25 名患者；CG2：29 名患者，对照组：50 名患者）接受了评估。CRE 和 CSE 主要由来自尿液来源的克雷伯菌属（63%）组成（28%）。在多变量分析中，重症监护病房（ICU）入住（比值比 [OR] 12.48；95%置信区间 [CI] 1.14-136.62；p = 0.04）和抗生素使用天数的累积数（OR 1.47；95% CI 1.02-2.16；p = 0.04）是 CRE 分离的独特独立预测因素；而累计的医疗保健暴露（OR 2.03；95% CI 1.20-3.41；p < 0.01）和万古霉素暴露（OR 6.70；95% CI 1.15-38.91；p = 0.03）是 CSE 的预测因素。
应考虑在需要 ICU 入住的患者中使用 CRE，特别是那些接受了多种抗生素治疗的患者。抗生素管理措施应针对减少所有抗生素暴露，而不是任何特定的抗生素类别，以降低 CRE 的风险。
