Clinical Characteristics and Risk Factors of CarbapenemResistant Enterobacteriaceae: A Case-Control Study in a Tertiary Hospital in Malaysia

ABSTRACT

@#Introduction: Carbapenem-resistant Enterobacteriaceae (CRE) is increasingly reported worldwide causing serious threats to healthcare. This study aimed to identify the common organisms associated with CRE, the clinical characteristics and risk factors for acquiring CRE infection and colonisation among hospitalised patients. Methods: This is a matched, case-control study. Patients aged 18 years and above whom were hospitalised from January 2019 to December 2019 and had CRE isolated from clinical specimens were matched with carbapenem-susceptible controls (CSE), based on gender and age. Univariate and multivariate statistical analysis was performed. Results: Among 184 patients, Klebsiella pneumoniae was the most common organism causing CRE infection and colonisation. Chronic kidney disease (p=0.025, OR3.12, 95% CI1.15-8.41), urinary catheterisation (p=0.005, OR3.67, 95% CI1.49- 9.00), prior use of cephalosporin (p<0.001, OR4.69, 95% CI1.96–11.22) and beta-lactam combination agent (p<0.001, OR7.18, 95% CI2.98-17.26) were identified as the independent risk factors. Conclusion: Chronic kidney disease, urinary catheterisation, prior use of cephalosporin and beta-lactam combination agents were independently associated with CRE infection and colonisation. These findings enable targeting potential CRE cohorts, hence, necessitate early undertaking of prevention measures to delay the onset of CRE. A rigorous effort by antibiotic stewardship an infection control team are pivotal.