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Ertapenem-Resistant Enterobacteriaceae Risk Factors for Acquisition and Outcomes

Published online by Cambridge University Press:  02 January 2015

E. P. Hyle ,
M. J. Ferraro ,
M. Silver ,
H. Lee  and
D. C. Hooper
E. P. Hyle*
Affiliation:
Division of Infectious Diseases, Boston, Massachusetts
M. J. Ferraro
Affiliation:
Department of Pathology, Boston, Massachusetts
M. Silver
Affiliation:
Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts
H. Lee
Affiliation:
Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts
D. C. Hooper
Affiliation:
Division of Infectious Diseases, Boston, Massachusetts
*
Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2696, (dhooper@partners.org)
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Abstract

Background and Objective.

Carbapenem resistance among Enterobacteriaceae is of concern because of increasing prevalence and limited therapeutic options. Limited research has been focused on understanding ertapenem resistance as a more sensitive marker for resistance to other carbapenems. We sought to determine risk factors for acquisition of ertapenem-resistant, meropenem-susceptible, or intermediate Enterobacteriaceae and to assess associated patient outcomes.

Design.

Retrospective case-control study among adult hospitalized inpatients.

Setting.

A 902-bed quaternary care urban hospital.

Results.

Sixty-two cases of ertapenem-resistant Enterobacteriaceae were identified from March 14, 2006, through October 31, 2007, and 62 unmatched control patients were randomly selected from other inpatients with cultures positive for ertapenem-susceptible Enterobacteriaceae. Thirty-seven (60%) of case patient isolates were Enterobacter cloacae, 20 (32%) were Klebsiella pneumoniae, and 5 (8%) were other species of Enterobacteriaceae. Risk factors for ertapenem-resistant Enterobacteriaceae infection included intensive care unit stay (odds ratio [OR], 4.6 [95% confidence interval {CI}, 2.0–10.3]), vancomycin-resistant Enterococcus colonization (OR, 7.1 [95% CI, 2.4–21.4]), prior central venous catheter use (OR, 10.0 [95% CI, 3.0–33.1]), prior receipt of mechanical ventilation (OR, 5.8 [95% CI, 2.1–16.2]), exposure to any antibiotic during the 30 days prior to a positive culture result (OR, 18.5 [95% CI, 4.9–69.9]), use of a β-lactam during the 30 days prior to a positive culture result (OR, 6.9 [95% CI, 3.0–16.0], and use of a carbapenem during the 30 days prior to a positive culture result (OR, 18.2 [95% CI, 2.6–130.0]). For the 62 case patients, 30-day outcomes from the time of positive culture result were 24 discharges (39%), 10 deaths (16%), and 28 continued hospitalizations (44%). The final end point of the hospitalization was discharge for 44 patients (71%) and death for 18 patients (29%).

Conclusions.

Ertapenem-resistant Enterobacteriaceae are important nosocomial pathogens. Multiple mechanisms of resistance maybe in operation. Additional study of ertapenem resistance is needed.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 12 , December 2010 , pp. 1242 - 1249
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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