title: Prevalence and risk factors for acquisition of carbapenem-resistant Enterobacteriaceae in the setting of endemicity.
abstract: OBJECTIVE
  To describe the epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) carriage and acquisition among hospitalized patients in an area of CRE endemicity.
  
  
  METHODS
  Cohort study with a nested case-control study.
  
  
  METHODS
  Two acute care, academic hospitals in New York City.
  
  
  METHODS
  All patients admitted to 7 study units, including intensive care, medical-surgical, and acute rehabilitation units.
  
  
  METHODS
  Perianal samples were collected from patients at admission and weekly thereafter to detect asymptomatic gastrointestinal carriage of CRE. A nested case-control study was performed to identify factors associated with CRE acquisition. Case patients were those who acquired CRE during a single hospitalization. Control subjects had no microbiologic evidence of CRE and at least 1 negative surveillance sample. Clinical data were abstracted from the medical record.
  
  
  RESULTS
  The prevalence of CRE in the study population was 5.4% (306 of 5,676 patients), and 104 patients met the case definition of acquisition during a single hospital stay. Mechanical ventilation (odds ratio [OR], 11.5), pulmonary disease (OR, 5.2), days of antibiotic therapy (OR, 1.04), and CRE colonization pressure (OR, 1.15) were independently associated with CRE acquisition. Pulsed-field gel electrophoresis analysis identified 87% of tested Klebsiella pneumoniae isolates as sharing related patterns (greater than 78% similarity), which suggests clonal transmission within and between the study hospitals.
  
  
  CONCLUSIONS
  Critical illness and underlying medical conditions, CRE colonization pressure, and antimicrobial exposure are important risk factors for CRE acquisition. Adherence to infection control practices and antimicrobial stewardship appear to be critical components of a CRE control program.
authors.affiliation: Department of Medicine, Mount Sinai School of Medicine, New York, New York.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Swaminathan
authors.forename: Saarika
authors.initials: S
authors.lastname: Sharma
authors.forename: Stephanie
authors.initials: S
authors.lastname: Poliansky Blash
authors.forename: Gopi
authors.initials: G
authors.lastname: Patel
authors.forename: David B
authors.initials: DB
authors.lastname: Banach
authors.forename: Michael
authors.initials: M
authors.lastname: Phillips
authors.forename: Vincent
authors.initials: V
authors.lastname: LaBombardi
authors.forename: Karen F
authors.initials: KF
authors.lastname: Anderson
authors.forename: Brandon
authors.initials: B
authors.lastname: Kitchel
authors.forename: Arjun
authors.initials: A
authors.lastname: Srinivasan
authors.forename: David P
authors.initials: DP
authors.lastname: Calfee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000382:microbiology; D015780:Carbapenems; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D016521:Electrophoresis, Gel, Pulsed-Field; D019353:Endemic Diseases; D005260:Female; D006785:Hospitals, University; D006786:Hospitals, Urban; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000302:isolation & purification*; D008171:Lung Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D015995:Prevalence; D012121:Respiration, Artificial / Q000009:adverse effects; D012307:Risk Factors; D055815:Young Adult; D018440:beta-Lactam Resistance
chemical_list: D015780:Carbapenems