Risk Factors for Rectal Colonization with Carbapenemase Producing <i>Enterobacteriaceae</i>

Abstract

Introduction: Carbapenem-resistant Enterobacteriaceae (CRE) is the most common pathogens acquired in intensive care units (ICU). Materials and Methods: This study was designed as prospective observational study at the Ankara Healthcare Application and Research Center of the University of Health Sciences. The study was conducted between September 2017 and May 2018 in the tertiary Anesthesiology and Reanimation ICU. Rectal swab samples were taken from each hospitalized patient during hospitalization and weekly thereafter. Sixty-five patients with CRE colonization were considered as the study group and 65 patients without CRE colonization were considered as the control group. Results: The 51% of the cases are male and 49% are females. The mean age of all cases was 69.1 +/- 17.6 and the median age was 73. The majority of bacteria grown in rectal swabs are constituted by Klebsiella pneumoniae (43-58.1%) and Escherichia colt (16-21.6%). Duration of hospitalization in the ICU was 19.6 +/- 15.8 in the control group and 48.5 +/- 38.2 in the study group. Duration of hospitalization in CRE-infected patients were longer than non-infected patients (p<0.001). The use of a central venous catheter and tracheostomy showed statistically significant difference between the groups (p< 0.05). Nineteen cases (29.2%) had CRE positivity at their admission to the ICU. Eighteen of these patients came from another clinical service or hospital (p< 0.005). In the control group, carbapenem was used in a mean of 11.9 +/- 9.9 days and in the study group a mean of 16.3 +/- 8.5 days (p= 0.002). In multivariate analysis of risk factors, duration of hospitalization in the ICU increases the risk of CRE positivity in rectal culture 1.04 (95%GA, 1,005-1,072, p= 0.024) times more. Conclusion: In our study, it can be said that it is important to question the indications of invasive procedures to be applied to the patients. We recommend that patients should be admitted to service follow-up when the ICU follow-up and treatment indications are terminated. Carbapenem treatment times should be shortened. As a result, it would be wise to take rectal surveillance cultures in ICUs to detect and control carbapenem-resistant strains.