Summary
Background
Intestinal clearance of carbapenemase-producing Enterobacterales (CPE-IC) is a cornerstone
to discontinue isolation precautions for CPE patients in hospitals. This study aimed
to evaluate the time to spontaneous CPE-IC and identify its potential associated risk
factors.
Methods
This retrospective cohort study was carried out between January 2018 and September
2020 on all patients in a 3200-bed teaching referral hospital with confirmed CPE intestinal
carriage. CPE-IC was defined as at least three consecutive CPE-negative rectal swab
cultures without a subsequent positive result. A survival analysis was performed to
determine the median time to CPE-IC. A multivariate Cox model was implemented to explore
the factors associated with CPE-IC.
Results
A total of 110 patients were positives for CPE, of whom 27 (24.5%) achieved CPE-IC.
Median time to CPE-IC was 698 days. Univariate analysis showed that female sex (P=0.046), multiple CPE-species in index cultures (P=0.005), Escherichia coli or Klebsiella spp. (P=0.001 and P=0.028, respectively) were significantly associated with the time to CPE-IC. Multivariate
analysis highlighted that identification of E. coli carbapenemase-producing or CPEs harbouring ESBL genes in index culture extended the
median time to CPE-IC, respectively (adjusted hazard ratio (aHR) = 0.13 (95% confidence
interval: 0.04–0.45]; P=0.001 and aHR = 0.34 (95% confidence interval: 0.12–0.90); P=0.031).
Conclusion
Intestinal decolonization of CPE can take several months to years to occur. Carbapenemase-producing
E. coli are likely to play a key role in delaying intestinal decolonization, probably through
horizontal gene transfer between species. Therefore, discontinuation of isolation
precautions in CPE-patients should be considered with caution.
Keywords
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Article info
Publication history
Published online: March 03, 2023
Accepted:
January 30,
2023
Received:
November 18,
2022
Identification
Copyright
© 2023 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
