Risk factors for acquisition of carbapenem resistant Enterobacteriaceae in an acute tertiary care hospital in Singapore

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Abstract

Background

Carbapenem resistant Enterobacteriaceae (CRE) is increasingly reported worldwide. A similar increase is seen in Singapore since identification of its first case in 2008. The aim of this study was to identify local risk factors for carriage of CRE in patients from an acute tertiary care hospital in Singapore.

Method

A matched case-control study was conducted on inpatients treated from January 1, 2011 till December 31, 2013. Two hundred and three cases of CRE infection or colonization were matched with 203 controls. CRE types were identified by PCR. Statistical analysis of data including a multivariate logistic regression analysis was done using SPSS 21.0.

Results

CREs were commonly seen in Klebsiella pneumoniae (42.2 %), Escherichia coli (24.3 %) and Enterobacter cloacae complex (17.2 %) in the 268 isolates. NDM-1 was the commonest CRE type seen (44.4 %), followed by KPC (39.9 %) whilst OXA-48 only constituted (7.8 %). Univariate analysis identified key risk factors associated with CRE as history of previous overseas hospitalization (OR: 33.667; 95 % CI: 4.539-259.700), admission to ICU (OR: 11.899; 95 % CI: 4.986-28.399) and HD/ICA (OR: 6.557; 95 % CI: 4.057-10.596); whilst a multivariate analysis revealed exposure to antibiotics penicillin (OR: 4.640; 95 % CI: 1.529-14.079] and glycopeptide (OR: 5.162; 95 % CI: 1.377-19.346) and presence of central line device (OR: 3.117; 95 % CI: 1.167-8.330) as significant independent predictors.

Conclusions

The identification of risk factors amongst our local population helped to refine the criteria used for target active surveillance screening for CRE amongst inpatients at time of hospital admission.

Related collections

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Author and article information

Contributors

Moi Lin Ling: ling.moi.lin@sgh.com.sg

Yong Ming Tee: tee.yong.ming@sgh.com.sg

Soong Geck Tan: tan.soong.geck@sgh.com.sg

Ismawati M. Amin: ismawati.mohd.amin@sgh.com.sg

Kue Bien How: molly.how.k.b@sgh.com.sg

Kwee Yuen Tan: tan.kwee.yuen@sgh.com.sg

Lai Chee Lee: lee.lai.chee@sgh.com.sg

Journal

Journal ID (nlm-ta): Antimicrob Resist Infect Control

Journal ID (iso-abbrev): Antimicrob Resist Infect Control

Title: Antimicrobial Resistance and Infection Control

Publisher: BioMed Central (London )

ISSN (Electronic): 2047-2994

Publication date (Electronic): 23 June 2015

Publication date PMC-release: 23 June 2015

Publication date Collection: 2015

Volume: 4

Electronic Location Identifier: 26

Affiliations

Infection Control, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore

Article

Publisher ID: 66

DOI: 10.1186/s13756-015-0066-3

PMC ID: 4477303

PubMed ID: 26106476

SO-VID: 5a0fcfe7-78b1-4495-b2cd-41335688686f

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.