Table 1.
Characteristics of Patients in the Medical Intensive Care Unit (MICU) and Solid Organ Transplant (SOT) Unit with Carbapenem-Resistant Organism (CRO) and Carbapenemase-Producing Organism (CPO) Perirectal Colonization at Unit Admission
| Variables at or Preceding Unit Admissiona | Total Swabbed Cohort | CRO Colonized | CPO Colonized |
| n = 2878 | n = 217 | n = 36 | |
| DEMOGRAPHICS | |||
| Age | 55 ± 15.4 | 59 ± 16.1** | 59 ± 15.85 |
| Female sex | 1325 (46%) | 99 (46%) | 14 (44%) |
| Race | |||
| White | 1317 (46%) | 111 (51%) | 17 (47%) |
| Black | 1272 (44%) | 81 (37%) | 12 (33%) |
| Asian | 61 (2%) | 5 (2%) | 1 (3%) |
| American Indian, Alaska Native or Native Hawaiian, or Pacific Islander | 13 (0.5%) | 0 (0%) | 0 (0%) |
| Other | 215 (8%) | 20 (9%) | 6 (17%) |
| Foreign Permanent Residence | 29 (1%) | 4 (1.8%) | 1 (3%) |
| ENCOUNTER-LEVEL CHARACTERISTICS | |||
| Admission type | |||
| Emergency/urgent (non-trauma) | 2646 (92%) | 210 (97%) | 35 (97%) |
| Trauma | 26 (1%) | 1 (0.5%) | 1 (3%) |
| Non-urgent/elective | 206 (7%) | 6 (3%) | 0 (0%) |
| Admission source | |||
| ER/Community | 2353 (82%) | 154 (71%) | 27 (75%) |
| Acute care hospital, direct transfer | 434 (15%) | 46 (21%)** | 7 (19%) |
| Post-acute care facility (non-acute), direct transfer | 74 (3%) | 16 (7%)*** | 2 (6%) |
| Other/unknown | 17 (0.6%) | 1 (0.5%) | 0 (0%) |
| ELIXHAUSER COMORBIDITY SCORE AND SELECT PRE-EXISTING MEDICAL CONDITIONS | |||
| Elixhauser Score, median (IQR) | 4 (2 – 7) | 5 (3–7) | 5 (3.5–6) |
| Chronic peptic ulcer disease | 81 (3%) | 10 (5%) | 2 (6%) |
| Solid tumor without metastasis | 468 (16%) | 41 (19%) | 9 (25%) |
| Metastatic cancer | 197 (7%) | 24 (11%) | 4 (11%) |
| Renal failure | 1164 (40%) | 89 (41%) | 14 (39%) |
| Liver disease | 852 (30%) | 55 (25%) | 13 (36%) |
| Diabetes | 912 (32%) | 82 (38%)* | 11 (31%) |
| Iron-deficiency anemia | 1203 (42%) | 103 (48%) | 20 (56%) |
| Chronic pulmonary disease | 630 (22) | 49 (23%) | 7 (19%) |
| Paralysis | 68 (2%) | 12 (6%)*** | 3 (8%)** |
| Human Immunodeficiency Virus positive | 159 (6%) | 8 (4%) | 1 (3%) |
| Immunosuppressed1 | 772 (27%) | 69 (32%) | 15 (42%) |
| INDWELLING HARDWARE OR EXTERNAL DEVICES AT ADMISSION | 887 (31%) | 89 (41%)** | 17 (47%) |
| Central line2 | 393 (14%) | 42 (19%)* | 10 (28%)** |
| Urologic catheter | 631 (22%) | 55 (25%) | 11 (31%) |
| Mechanical ventilation | 207 (7%) | 22 (10%) | 1 (3%) |
| Gastrointestinal upper or lower tube | 122 (4%) | 10 (5%) | 0 (0%) |
| Fecal management device | 8 (0.3%) | 2 (0.9%) | 1 (3%) |
| Ostomy pouching system | 1 (0.03%) | 1 (0.5%) | 1 (3%) |
| INDWELLING HARDWARE OR EXTERNAL DEVICES (< 3 MONTHS) | 1148 (40%) | 112 (52%)*** | 24 (67%)** |
| Central line2 | 569 (20%) | 58 (27%)** | 16 (44%)*** |
| Urologic catheter | 876 (30%) | 76 (35%)* | 16 (44%)* |
| Mechanical ventilation | 324 (11%) | 39 (18%)* | 8 (22%)* |
| Gastrointestinal upper or lower tube | 189 (7%) | 27 (12%)** | 3 (8%) |
| Fecal management device | 0 (0%) | 0 (0%) | 0 (0%) |
| Ostomy pouching system | 13 (0.5%) | 9 (4%)*** | 2 (6%)*** |
| INFECTION CONTROL CHARACTERISTICS AT ADMISSION | |||
| On Contact Precautions at Admission3 | 796 (28%) | 100 (46%)*** | 20 (56%)* |
| Admission Swab Positive for VRE Colonization | 315 (11%) | 51 (24%)*** | 12 (33%)*** |
| RECENT MULTIDRUG-RESISTANT ORGANISM HISTORY (COLONIZATION OR INFECTION <6 MONTHS) | |||
| Vancomycin-resistant Enterococcus species. | 274 (10%) | 39 (18%)*** | 12 (33%)*** |
| Methicillin-resistant Staphylococcus aureus | 168 (6%) | 28 (13%)*** | 7 (19%)*** |
| Extended-spectrum β-lactamase (ESBL) or ceftriaxone-resistant Enterobacteriaceae | 107 (4%) | 30 (14%)*** | 9 (25%)*** |
| Carbapenem-resistant organism (CRO) | 74 (3%) | 34 (16%)*** | 14 (39%)*** |
| Carbapenem-resistant Enterobacteriaceae (CRE) | 11 (0.4%) | 7 (3%)*** | 6 (17%)*** |
| Carbapenem-resistant glucose non-fermenting bacilli (NFCRO) | 64 (2%) | 27 (12%)*** | 8 (22%)*** |
| Multidrug-resistant Pseudomonas species4 | 28 (1%) | 12 (6%)*** | 2 (6%)*** |
| Multidrug-resistant Acinetobacter species4 | 41 (1%) | 9 (4%)*** | 4 (11%)*** |
| RECENT MEDICATION EXPOSURE (< 3 MONTHS) | |||
| Immunosuppressive therapy5 | 620 (22%) | 63 (29%)* | 14 (39%) |
| Gastric Acid Suppressants6 | 611 (21%) | 76 (35%)*** | 17 (47%)** |
| RECENT ANTIBIOTIC EXPOSURE (<3 MONTHS) | |||
| Extended-spectrum penicillin therapy | 313 (11%) | 43 (20%)*** | 12 (33%)** |
| Third and fourth-generation cephalosporin therapy | 379 (13%) | 37 (17%) | 9 (25%) |
| Aztreonam therapy | 21 (0.7%) | 6 (3%)** | 1 (3%) |
| Carbapenems | 128 (4%) | 30 (14%)*** | 8 (22%)*** |
| Fluoroquinolone therapy | 144 (5%) | 21 (10%)** | 4 (11%) |
| Aminoglycoside therapy | 49 (2%) | 14 (7%)*** | 2 (6%) |
| Any antibiotics (combined) | 607 (21%) | 72 (33%)*** | 14 (39%) |
| DURATION OF TIME FROM HOSPITAL ADMISSION TO UNIT ADMISSION (DAYS), MEDIAN (IQR) | 0 (0 – 1) | 0 (0–2)*** | 0 (0–4.5)*** |
| RECENT INTERNATIONAL EXPOSURE | |||
| International Hospitalization (1+ nights, < 6 Months) | 30 (1%) | 4 (2%) | 1 (3%) |
| International travel, patient or spouse (< 21 days) | 18 (0.6%) | 3 (1%) | 2 (6%)*** |
| OTHER HIGH-RISK HEALTHCARE EXPOSURES (<6 MONTHS) | |||
| Inpatient hospitalization | 1553 (54%) | 132 (61%)* | 21 (58%) |
| Intensive care unit | 503 (18%) | 60 (28%)*** | 12 (33%)* |
| Post-acute care facility | 173 (6%) | 32 (15%)*** | 7 (19%)** |
| Long-term acute care hospital | 34 (1%) | 8 (4%)** | 0 (0%) |
| Skilled nursing or rehabilitation facility | 153 (5%) | 29 (13%)*** | 7 (19%)*** |
| INVASIVE PROCEDURES (< 3 MONTHS) | |||
| Endoscopy | 330 (12%) | 41 (19%)** | 6 (17%) |
| Lower endoscopy | 93 (3%) | 12 (6%) | 2 (6%) |
| Upper endoscopy | 302 (11%) | 33 (15%)* | 6 (17%) |
| Bronchoscopy | 56 (2%) | 3 (1%) | 0 (0%) |
| Surgery | 306 (11%) | 16 (7%) | 4 (11%) |
| Colorectal surgery | 6 (0.2%) | 1 (0.5%) | 1 (3%)** |
| Abdominal surgery | 282 (10%) | 14 (7%) | 3 (8%) |
| Urologic surgery | 22 (0.8%) | 1 (0.5%) | 0 (0%) |
Table 1 does not include all variables and permutations evaluated in prediction models.
Significant at a P-value of ≤ 0.05 (*), ≤ 0.01 (**), or ≤ 0.001 (***), based upon a 2-tailed significance test, in univariable logistic regression with general estimating equations and robust standard errors to account for patient-clustering due to repeat unit admissions.
Receipt of chemotherapy or immunosuppressive therapy in the prior 3 months, human immunodeficiency virus (HIV)-positive, and/or documented CBC immunosuppressive abnormalities within 24 hours preceding unit admission (defined as absolute neutrophil counts or total WBC counts less than 500 cells/mm3).
Defined in reference to the National Healthcare Safety Network (NHSN) 2018 definition of “central line,” available at: https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf.
Indications for contact precautions are a flagged history of: (1) methicillin-resistant Staphylococcus aureus (MRSA); (2) Vancomycin-resistant Enterococcus (VRE); (3) Clostridioides difficile; (4) Multidrug-resistant Gram-negative (MDRGN) bacteria; (5) CRE (which are classified separately from other MDRGNs at JHH); (6) Respiratory viruses; and (7) Other indications, including “CRE rule-out” for patients recently hospitalized internationally (≤ 6 mos.), enteric pathogens, and contact precautions without associated infection control flag(s).
Resistant to 4 of 5 antibiotic classes tested.
Immunosuppressant or non-topical glucocorticoid.
Proton-pump inhibitors (PPIs) or histamine H2-receptor antagonists (H2-Blockers). These medications were analyzed as a composite category in logistic regression, but were evaluated both individually and as a composite category in predictive models.