title: Recent exposure to antimicrobials and carbapenem-resistant Enterobacteriaceae: the role of antimicrobial stewardship.
abstract: BACKGROUND
  Carbapenem-resistant Enterobacteriaceae (CRE) are rapidly emerging worldwide. Control group selection is critically important when analyzing predictors of antimicrobial resistance. Focusing on modifiable risk factors can optimize prevention and resource expenditures. To identify specific predictors of CRE, patients with CRE were compared with 3 control groups: (1) patients with extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, (2) patients with non-ESBL-containing Enterobacteriaceae, and (3) uninfected controls.
  
  
  METHODS
  Matched multivariable analyses.
  
  
  METHODS
  Patients possessing CRE that were isolated at Detroit Medical Center from September 1, 2008, to August 31, 2009.
  
  
  METHODS
  Patients were matched (1∶1 ratio) to the 3 sets of controls. Matching parameters included (1) bacteria type, (2) hospital/facility, (3) unit/clinic, (4) calendar year, and (5) time at risk (ie, from admission to culture). Matched multivariable analyses were conducted between uninfected controls and patients with CRE, ESBL, and non-ESBL Enterobacteriaceae. Models were also designed comparing patients with CRE to patients with ESBL, patients with non-ESBL Enterobacteriaceae, and all 3 non-CRE groups combined.
  
  
  RESULTS
  Ninety-one unique patients with CRE were identified, and 6 matched models were constructed. Recent (less than 3 months) exposure to antibiotics was the only parameter that was consistently associated with CRE, regardless of the group to which CRE was compared, and was not independently associated with isolation of ESBL or non-ESBL Enterobacteriaceae.
  
  
  CONCLUSIONS
  Exposure to antibiotics within 3 months was an independent predictor that characterized patients with CRE isolation. As a result, antimicrobial stewardship efforts need to become a major focus of preventive interventions. Regulatory focus regarding appropriate antimicrobial use might decrease the detrimental effects of antibiotic misuse and spread of CRE.
authors: Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA. drormc@hotmail.com
authors: Dror
authors: D
authors: Marchaim
authors: Teena
authors: T
authors: Chopra
authors: Ashish
authors: A
authors: Bhargava
authors: Christopher
authors: C
authors: Bogan
authors: Sorabh
authors: S
authors: Dhar
authors: Kayoko
authors: K
authors: Hayakawa
authors: Jason M
authors: JM
authors: Pogue
authors: Suchitha
authors: S
authors: Bheemreddy
authors: Christopher
authors: C
authors: Blunden
authors: Maryann
authors: M
authors: Shango
authors: Jessie
authors: J
authors: Swan
authors: Paul R
authors: PR
authors: Lephart
authors: Federico
authors: F
authors: Perez
authors: Robert A
authors: RA
authors: Bonomo
authors: Keith S
authors: KS
authors: Kaye
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000494:pharmacology*; D015780:Carbapenems / Q000494:pharmacology*; D016022:Case-Control Studies; D004363:Drug Utilization; D004755:Enterobacteriaceae / Q000378:metabolism; D004756:Enterobacteriaceae Infections / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012307:Risk Factors; D018440:beta-Lactam Resistance / Q000187:drug effects*; D001618:beta-Lactamases / Q000096:biosynthesis
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D001618:beta-Lactamases