TABLE 2.
Association between antecedent carbapenem exposure and types of carbapenem-resistant Enterobacteriaceaea
| Variable | Patients with: |
Values by analysis |
||||
|---|---|---|---|---|---|---|
|
NCPCREb (n = 387) |
CPEbc (n = 456) |
Univariate |
Multivariated
|
|||
| OR (95% CI) | P value | aOR (95% CI) | P value | |||
| Exposure of interest | ||||||
| Carbapenem exposed | 197 (50.9) | 118 (25.9) | 2.97 (2.22–3.97) | <0.001 | 3.48 (2.39–5.09) | <0.001 |
| Demographics | ||||||
| Gender, male | 200 (51.7) | 273 (59.9) | 0.72 (0.55–0.94) | 0.02 | 0.69 (0.51–0.94)e | 0.02 |
| Age, median years (IQR) | 68 (57–80) | 67 (58–77) | 0.55 | |||
| Medical history (1 year before culture) | ||||||
| Charlson score, median (IQR) | 5 (3–8) | 6 (3–8) | 0.05 | 0.97 (0.92–1.01) | 0.15 | |
| Hospitalization | 255 (65.9) | 327 (71.7) | 0.76 (0.57–1.02) | 0.07 | 0.70 (0.50–0.99)e | 0.05 |
| Upper gastrointestinal scopes | 80 (20.7) | 108 (23.7) | 0.84 (0.61–1.16) | 0.30 | ||
| Lower gastrointestinal scopes | 47 (12.1) | 53 (11.6) | 1.05 (0.69–1.60) | 0.82 | ||
| Surgery | 241 (62.3) | 305 (66.9) | 0.82 (0.62–1.08) | 0.16 | ||
| Multidrug-resistant organismsf | 152 (39.3) | 167 (36.6) | 1.12 (0.85–1.48) | 0.43 | ||
| Current hospitalization | ||||||
| Time at riskg , median days (IQR) | 12 (2–31) | 8 (1–23.5) | <0.001 | 1.00 (0.99–1.00) | 0.34 | |
| ICU at the time of culture | 85 (22.0) | 124 (27.2) | 0.75 (0.55–1.03) | 0.08 | 0.54 (0.37–0.81)e | 0.003 |
| Feeding tubeh | 144 (37.2) | 157 (34.4) | 1.13 (0.85–1.50) | 0.40 | ||
| Central venous lineh | 164 (42.4) | 160 (35.1) | 1.36 (1.03–1.80) | 0.03 | 0.99 (0.69–1.43) | 0.97 |
| Antibiotic exposure during 30 days before culture (proportions) | ||||||
| Third- and fourth-generation cephalosporins | 122 (31.5) | 125 (27.4) | 1.22 (0.91–1.64) | 0.19 | 1.00 (0.67–1.49) | >0.99 |
| Extended-spectrum penicillins | 228 (58.9) | 258 (56.6) | 1.10 (0.84–1.45) | 0.49 | 1.09 (0.80–1.48) | 0.60 |
| Fluoroquinolones | 100 (25.8) | 87 (19.1) | 1.48 (1.07–2.05) | 0.02 | 1.15 (0.80–1.68) | 0.45 |
| Aminoglycosides | 66 (17.1) | 52 (11.4) | 1.60 (1.08–2.36) | 0.02 | 1.02 (0.64–1.63) | 0.93 |
| Tigecycline | 9 (2.3) | 9 (1.9) | 1.18 (0.46–3.00) | 0.73 | ||
| Trimethoprim-sulfamethoxazole | 37 (9.6) | 17 (3.7) | 2.73 (1.51–4.93) | 0.001 | 2.44 (1.27–4.69) | 0.01 |
| Metronidazole | 94 (24.3) | 89 (19.5) | 1.32 (0.95–1.84) | 0.10 | 1.20 (0.78–1.84) | 0.42 |
| Specimen type | ||||||
| Clinical cultures (versus surveillance cultures) | 224 (57.9) | 201 (44.1) | 1.74 (1.33–2.29) | <0.001 | 1.03 (0.74–1.43) | 0.87 |
Abbreviations: NCPCRE, non-carbapenemase-producing carbapenem-resistant Enterobacteriaceae; CPE, carbapenemase-producing Enterobacteriaceae; ICU, intensive care unit; IQR, interquartile range; OR, odd ratio; aOR, adjusted odds ratio.
Unless otherwise indicated, values are n (%).
CPE is the reference comparison group (control group) unless stated otherwise.
Random effect logistic regression model allowing for clustering within hospitals and adjusted for month of CRE sample collection. Statistically significant values are shown in boldface.
For ease of interpretation of risk factors for CPE, the logistic regression model was repeated with NCPCRE as the reference group and the results were as follows: male gender (aOR,1.45; 95% CI, 1.07 to 1.97; P = 0.02); hospitalization during preceding 1 year (aOR, 1.42; 95% CI, 1.01 to 2.02; P = 0.05), and being in the ICU at the time of culture (aOR, 1.84; 95% CI, 1.24 to 2.74; P = 0.003).
Multidrug-resistant organisms includes methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Acinetobacter baumannii (CRAB), vancomycin-resistant enterococci (VRE), and carbapenem-resistant Pseudomonas aeruginosa (CRPA).
Days from admission to collection of culture.
During time at risk.