Abstract：
Carbapenem-resistant Enterobacteriaceae (CRE) infection has become a major challenge to clinicians. The aim of this study is to identify the risk factors of acquiring CRE to guide more targeted screening for hospital admissions.
This is a retrospective case-control study (ratio 1:1) where a patient with CRE infection or colonisation was matched with a control. The control was an individual who tested negative for CRE but was a close contact of a patient testing positive and was admitted at the same time and place. Univariate and multivariate statistical analyses were done.
The study included 154 patients. The majority of the CRE was Klebsiella species (83%). From univariate analysis, the significant risk factors were having a history of indwelling devices (OR: 2.791; 95% CI: 1.384-5.629), concomitant other MDRO (OR: 2.556; 95% CI: 1.144-5.707) and hospitalisation for more than three weeks (OR: 2.331; 95% CI: 1.163-4.673). Multivariate analysis showed that being unable to ambulate on admission (adjusted OR: 2.345; 95% CI: 1.170-4.699) and antibiotic exposure (adjusted OR: 3.515; 95% CI: 1.377-8.972) were independent predictors. The in-hospital mortality rate of CRE infection was high (64.5%). CRE acquisition resulted in prolonged hospitalisation (median=35 days; P<0.001).
CRE infection results in high morbidity and mortality. On top of the common risk factors, patients with mobility restriction, prior antibiotic exposures and hospitalisation for more than three weeks should be prioritised in the screening strategy to control the spread of CRE.
This is a retrospective case-control study (ratio 1:1) where a patient with CRE infection or colonisation was matched with a control. The control was an individual who tested negative for CRE but was a close contact of a patient testing positive and was admitted at the same time and place. Univariate and multivariate statistical analyses were done.
The study included 154 patients. The majority of the CRE was Klebsiella species (83%). From univariate analysis, the significant risk factors were having a history of indwelling devices (OR: 2.791; 95% CI: 1.384-5.629), concomitant other MDRO (OR: 2.556; 95% CI: 1.144-5.707) and hospitalisation for more than three weeks (OR: 2.331; 95% CI: 1.163-4.673). Multivariate analysis showed that being unable to ambulate on admission (adjusted OR: 2.345; 95% CI: 1.170-4.699) and antibiotic exposure (adjusted OR: 3.515; 95% CI: 1.377-8.972) were independent predictors. The in-hospital mortality rate of CRE infection was high (64.5%). CRE acquisition resulted in prolonged hospitalisation (median=35 days; P<0.001).
CRE infection results in high morbidity and mortality. On top of the common risk factors, patients with mobility restriction, prior antibiotic exposures and hospitalisation for more than three weeks should be prioritised in the screening strategy to control the spread of CRE.
摘要：
耐碳青霉烯类肠杆菌（CRE）感染已成为临床医生面临的主要挑战。这项研究的目的是确定获得CRE的风险因素，以指导更有针对性的住院筛查。
这是一项回顾性病例对照研究（比例1：1），其中CRE感染或定植的患者与对照相匹配。对照是CRE测试阴性但与测试阳性的患者密切接触的个体,并且在相同时间和地点入院。进行单变量和多变量统计分析。
该研究包括154名患者。大多数CRE是克雷伯菌属(83%)。从单变量分析来看，显著的危险因素是有留置器械的病史(OR:2.791;95%CI:1.384-5.629),合并其他MDRO(OR:2.556;95%CI:1.144-5.707)和住院超过3周(OR:2.331;95%CI:1.163-4.673).多因素分析显示，入院时无法走动（调整后OR：2.345；95％CI：1.170-4.699）和抗生素暴露（调整后OR：3.515；95％CI：1.377-8.972）是独立预测因素。CRE感染的院内死亡率很高（64.5％）。获得CRE导致住院时间延长(中位数=35天;P<0.001)。
CRE感染导致高发病率和死亡率。除了常见的风险因素，行动不便的患者，在筛查策略中,应优先考虑既往抗生素暴露和住院超过3周的情况,以控制CRE的传播.
这是一项回顾性病例对照研究（比例1：1），其中CRE感染或定植的患者与对照相匹配。对照是CRE测试阴性但与测试阳性的患者密切接触的个体,并且在相同时间和地点入院。进行单变量和多变量统计分析。
该研究包括154名患者。大多数CRE是克雷伯菌属(83%)。从单变量分析来看，显著的危险因素是有留置器械的病史(OR:2.791;95%CI:1.384-5.629),合并其他MDRO(OR:2.556;95%CI:1.144-5.707)和住院超过3周(OR:2.331;95%CI:1.163-4.673).多因素分析显示，入院时无法走动（调整后OR：2.345；95％CI：1.170-4.699）和抗生素暴露（调整后OR：3.515；95％CI：1.377-8.972）是独立预测因素。CRE感染的院内死亡率很高（64.5％）。获得CRE导致住院时间延长(中位数=35天;P<0.001)。
CRE感染导致高发病率和死亡率。除了常见的风险因素，行动不便的患者，在筛查策略中,应优先考虑既往抗生素暴露和住院超过3周的情况,以控制CRE的传播.
