title: Predictors of rectal carriage of carbapenem-resistant Enterobacteriaceae (CRE) among patients with known CRE carriage at their next hospital encounter.
abstract: BACKGROUND
  Carbapenem-resistant Enterobacteriaceae (CRE) are important extremely drug-resistant pathogens that have emerged during the past decade. Early identification and isolation of carriers are key components of an effective infection control strategy in healthcare facilities. Very little is known about the natural history of CRE carriage. We aimed to determine the predictors of a positive CRE rectal screen test among patients with known CRE carriage screened at their next hospital encounter.
  
  
  METHODS
  A case-control study was conducted. Sixty-six patients who tested positive for CRE carriage were surveyed for CRE rectal carriage at the next hospital encounter; screen-positive patients were compared with screen-negative control patients. Data were extracted from the patients' medical records and from the hospital computerized database.
  
  
  RESULTS
  Twenty-three case patients and 43 control patients were identified. Predictors for a positive CRE rectal carriage test were (1) prior fluoroquinolone use (odds ratio [OR], 4.27; 95% confidence interval [CI], 1.10-16.6), (2) admission from an institution or another hospital (OR, 4.04; 95% CI, 1.33-12.37), and (3) time interval less than or equal to 3 months since the first positive CRE test (OR, 3.59; 95% CI, 1.24-10.37). Among patients with no predictor variables, the likelihood of having a positive screen test at the next hospital encounter was 1/7. If they had at least 1 predictor, the likelihood increased to 1/2.
  
  
  CONCLUSIONS
  Prior fluoroquinolone use, transfer from another healthcare facility, and admission less than or equal to 3 months since the first CRE isolation are predictors of persistent CRE rectal carriage. These predictors can be used in designing CRE prevention strategies.
authors.affiliation: Division of Epidemiology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel. vereds@tasmc.health.gov.il
authors.forename: Vered
authors.initials: V
authors.lastname: Schechner
authors.forename: Tali
authors.initials: T
authors.lastname: Kotlovsky
authors.forename: Jalal
authors.initials: J
authors.lastname: Tarabeia
authors.forename: Meital
authors.initials: M
authors.lastname: Kazma
authors.forename: David
authors.initials: D
authors.lastname: Schwartz
authors.forename: Shiri
authors.initials: S
authors.lastname: Navon-Venezia
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Carmeli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015780:Carbapenems; D002353:Carrier State / Q000453:epidemiology*; D016022:Case-Control Studies; D004755:Enterobacteriaceae / Q000302:isolation & purification*; D005260:Female; D024841:Fluoroquinolones; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010359:Patient Readmission; D010360:Patient Transfer; D012007:Rectum / Q000382:microbiology*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D024841:Fluoroquinolones