Mark A. Caudell , Carmen Castillo , Lucas F. Santos , Laura Grajeda , Juan Carlos Romero , Maria Renee Lopez , Sylvia Omulo , Mariangeli Freitas Ning , Guy H. Palmer , Douglas R. Call , Celia Cordon-Rosales , Rachel M. Smith , Carolyn T.A. Herzig , Ashley Styczynski , Brooke M. Ramay
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To identify the factors associated with ESCrE and CRE colonization within hospitals, we enrolled hospitalized patients at a regional hospital located in Guatemala.</p></div><div><h3>Methods</h3><p>Stool samples were collected from randomly selected patients using a cross-sectional study design (March-September, 2021), and samples were tested for the presence of ESCrE and CRE. Hospital-based and household variables were examined for associations with ESCrE and CRE colonization using lasso regression models, clustered by ward (n = 21).</p></div><div><h3>Results</h3><p>A total of 641 patients were enrolled, of whom complete data sets were available for 593. Colonization with ESCrE (72.3%, n = 429/593) was negatively associated with carbapenem administration (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.11-0.42) and positively associated with ceftriaxone administration (OR 1.61, 95% CI 1.02-2.53), as was reported hospital admission within 30 days of the current hospitalization (OR 2.84, 95% CI 1.19-6.80). Colonization with CRE (34.6%, n = 205 of 593) was associated with carbapenem administration (OR 2.62, 95% CI 1.39-4.97), reported previous hospital admission within 30 days of current hospitalization (OR 2.58, 95% CI 1.17-5.72), hospitalization in wards with more patients (OR 1.05, 95% CI 1.02-1.08), hospitalization for ≥4 days (OR 3.07, 95% CI 1.72-5.46), and intubation (OR 2.51, 95% CI 1.13-5.59). No household-based variables were associated with ESCrE or CRE colonization in hospitalized patients.</p></div><div><h3>Conclusion</h3><p>The hospital-based risk factors identified in this study are similar to what has been reported for risk of health care–associated infections, consistent with colonization being driven by hospital settings rather than community factors. This also suggests that colonization with ESCrE and CRE could be a useful metric to evaluate the efficacy of infection and prevention control programs in clinics and hospitals.</p></div>","PeriodicalId":73335,"journal":{"name":"IJID regions","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2024-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772707624000328/pdfft?md5=64b828b11ec8b4ce4735642b53b44768&pid=1-s2.0-S2772707624000328-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Risk factors for colonization with extended-spectrum cephalosporin-resistant and carbapenem-resistant Enterobacterales among hospitalized patients in Guatemala: An Antibiotic Resistance in Communities and Hospitals (ARCH) study\",\"authors\":\"Mark A. Caudell , Carmen Castillo , Lucas F. Santos , Laura Grajeda , Juan Carlos Romero , Maria Renee Lopez , Sylvia Omulo , Mariangeli Freitas Ning , Guy H. Palmer , Douglas R. Call , Celia Cordon-Rosales , Rachel M. Smith , Carolyn T.A. Herzig , Ashley Styczynski , Brooke M. Ramay\",\"doi\":\"10.1016/j.ijregi.2024.100361\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objectives</h3><p>The spread of extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE) has resulted in increased morbidity, mortality, and health care costs worldwide. To identify the factors associated with ESCrE and CRE colonization within hospitals, we enrolled hospitalized patients at a regional hospital located in Guatemala.</p></div><div><h3>Methods</h3><p>Stool samples were collected from randomly selected patients using a cross-sectional study design (March-September, 2021), and samples were tested for the presence of ESCrE and CRE. Hospital-based and household variables were examined for associations with ESCrE and CRE colonization using lasso regression models, clustered by ward (n = 21).</p></div><div><h3>Results</h3><p>A total of 641 patients were enrolled, of whom complete data sets were available for 593. Colonization with ESCrE (72.3%, n = 429/593) was negatively associated with carbapenem administration (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.11-0.42) and positively associated with ceftriaxone administration (OR 1.61, 95% CI 1.02-2.53), as was reported hospital admission within 30 days of the current hospitalization (OR 2.84, 95% CI 1.19-6.80). 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引用次数: 0
摘要
目的耐广谱头孢菌素肠杆菌(ESCRE)和耐碳青霉烯类肠杆菌(CRE)的传播已导致全球发病率、死亡率和医疗费用的增加。为了确定与医院内ESCrE和CRE定植相关的因素,我们在危地马拉的一家地区医院招募了住院患者。方法采用横断面研究设计(2021年3月至9月)从随机挑选的患者中收集工具样本,并检测样本中是否存在ESCrE和CRE。使用拉索回归模型检测医院和家庭变量与 ESCrE 和 CRE 定植的相关性,按病房分组(n = 21)。ESCrE定植(72.3%,n = 429/593)与碳青霉烯类用药呈负相关(比值比 [OR] 0.21,95% 置信区间 [CI] 0.11-0.42),与头孢曲松用药呈正相关(OR 1.61,95% CI 1.02-2.53),与本次住院 30 天内的入院报告呈正相关(OR 2.84,95% CI 1.19-6.80)。CRE菌落(34.6%,593 例中的 205 例)与使用碳青霉烯类药物(OR 2.62,95% CI 1.39-4.97)、本次住院后 30 天内入院(OR 2.58,95% CI 1.17-5.72)、在病人较多的病房住院(OR 1.05,95% CI 1.02-1.08)、住院时间≥4 天(OR 3.07,95% CI 1.72-5.46)和插管(OR 2.51,95% CI 1.13-5.59)。本研究中发现的医院风险因素与已报道的医疗相关感染风险因素相似,这表明定植是由医院环境而非社区因素驱动的。这也表明,ESCrE 和 CRE 定植可作为评估诊所和医院感染和预防控制项目效果的有用指标。
Risk factors for colonization with extended-spectrum cephalosporin-resistant and carbapenem-resistant Enterobacterales among hospitalized patients in Guatemala: An Antibiotic Resistance in Communities and Hospitals (ARCH) study
Objectives
The spread of extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE) has resulted in increased morbidity, mortality, and health care costs worldwide. To identify the factors associated with ESCrE and CRE colonization within hospitals, we enrolled hospitalized patients at a regional hospital located in Guatemala.
Methods
Stool samples were collected from randomly selected patients using a cross-sectional study design (March-September, 2021), and samples were tested for the presence of ESCrE and CRE. Hospital-based and household variables were examined for associations with ESCrE and CRE colonization using lasso regression models, clustered by ward (n = 21).
Results
A total of 641 patients were enrolled, of whom complete data sets were available for 593. Colonization with ESCrE (72.3%, n = 429/593) was negatively associated with carbapenem administration (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.11-0.42) and positively associated with ceftriaxone administration (OR 1.61, 95% CI 1.02-2.53), as was reported hospital admission within 30 days of the current hospitalization (OR 2.84, 95% CI 1.19-6.80). Colonization with CRE (34.6%, n = 205 of 593) was associated with carbapenem administration (OR 2.62, 95% CI 1.39-4.97), reported previous hospital admission within 30 days of current hospitalization (OR 2.58, 95% CI 1.17-5.72), hospitalization in wards with more patients (OR 1.05, 95% CI 1.02-1.08), hospitalization for ≥4 days (OR 3.07, 95% CI 1.72-5.46), and intubation (OR 2.51, 95% CI 1.13-5.59). No household-based variables were associated with ESCrE or CRE colonization in hospitalized patients.
Conclusion
The hospital-based risk factors identified in this study are similar to what has been reported for risk of health care–associated infections, consistent with colonization being driven by hospital settings rather than community factors. This also suggests that colonization with ESCrE and CRE could be a useful metric to evaluate the efficacy of infection and prevention control programs in clinics and hospitals.