Risk factors for carbapenem resistant enterobacteriaceae in a teritiary hospital—A case control study.

Aim To study the risk factors for bacteremia by carbapenem resistant enterobacteriaceae (CRE). Material & methods This study is prospective observational Case Control study in subjects aged more than 18 years admitted at Kasturba Hospital, Manipal, India from June 2015 to July 2017. Subjects with blood cultures isolating CRE were designated cases and those with carbapenem-sensitive Enterobacteriaceae (CSE) were taken as controls. The case to control ratio was taken as 1:2 after gender and age matching. Statistical analysis was done using SPSS15.0. Results In 65 patients with CRE, the most common isolate was K. pneumoniae (52%), E. coli (42%), Enterobacter (3%), Proteus and Citrobacter accounting for 1% each. Among 130 controls, Klebsiella pneumoniae was (35%), E. coli (58%) and Enterobacter cloacae (4%) and Proteus (2%). Analyzing the risk factors in our study, we found that exposure to mechanical ventilation (OR: 3.858, 95% CI: 1.139–13.067; P = 0.03) and antibiotic exposure (OR: 3.342; 95% CI: 0.231–9.70; P = 0.012) were the significant risk factors. Other factors not found to be significant were Diabetes mellitus, cirrhosis, chronic kidney disease, HIV positive status, prior major surgery, presence of open wounds, malignancy, exposure to other invasive devices like central line and urinary catheter. Conclusion In our study, we found exposure to endotracheal tube and antibiotic exposure significant in causing CRE. Hence, exposure to antibiotics and mechanical ventilation need to be significantly monitored and avoided to reduce CRE infections. [ABSTRACT FROM AUTHOR]

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