Summary
Objectives
To examine whether carbapenem-resistant Enterobacteriaceae (CRE) carriage is associated
with incidence of clinical infection as a means of assessing whether the morbidity
and mortality associated with these bacteria are mediated by underlying conditions
or intrinsic properties of CRE.
Methods
This retrospective matched cohort study compared the incidence of invasive infections
in CRE-colonized patients and matched non-carriers in the intensive care unit (ICU).
The primary outcome was infection caused by CRE of the same species as the colonizing
strain among CRE carriers, and infections caused by carbapenem-sensitive strains of
the same organism in non-carriers. Hospital discharge and death were considered as
competing events. Competing-risks hazard analysis was performed for the entire cohort
and for a nested cohort matched by Acute Physiology and Chronic Health Evaluation
(APACHE) II scores, stratified by matching.
Results
In total, 146 CRE carriers were compared with 292 non-carriers. Patients were well
matched for most risk factors for Enterobacteriaceae infection, including age, renal
failure, previous invasive infection, previous hospitalization, APACHE II score, length
of mechanical ventilation, length of hospitalization and CRE carriage. On regression
analysis, colonization with CRE was independently associated with Enterobacteriaceae
infection {cause-specific hazard ratio (CSHR) 2.06 [95% confidence interval (CI) 1.03–4.09]}.
On regression analysis of the APACHE-II-matched cohort (N=284), colonization with CRE remained significantly associated with Enterobacteriaceae
infection [CSHR 3.32 (95% CI 1.31–8.43)].
Conclusions
Colonization with CRE was associated with at least a two-fold increased risk of infection
by the colonizing strain amongst ICU patients.
Keywords
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Article info
Publication history
Published online: June 06, 2016
Accepted:
May 31,
2016
Received:
February 18,
2016
Identification
Copyright
© 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
