Risk factors for the acquisition of carbapenem-resistant Escherichia coli at a tertiary care center in South Korea: a matched case-control study.
BACKGROUND
Carbapenem resistance among gram-negative bacilli is an emerging threat worldwide. The objective of this study was to identify risk factors for the acquisition of carbapenem-resistant Escherichia coli (CRE).


METHODS
We conducted a matched case-control study comprising 57 cases of acquisition of CRE and 114 controls (1:2 matched) selected from patients with a culture of carbapenem-susceptible E coli between January 2006 and December 2010 at a 2000-bed tertiary care center in South Korea.


RESULTS
On univariate analysis, previous use of carbapenem (P < .01), fluoroquinolone (P < .01), and glycopeptide (P < .01), as well as length of hospital stay (P < .05), were significantly associated with CRE acquisition. On multivariate analysis, previous use of carbapenem (odds ratio [OR], 4.56; 95% confidence interval [CI] 1.44-14.46; P = .01) and previous use of fluoroquinolone (OR, 2.81; 95% CI, 1.14-6.99; P = .03) were independent risk factors.


CONCLUSIONS
At this institute, the antibiotic selective pressure of carbapenems and fluoroquinolones was shown to be an important risk factor for the acquisition of CRE.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Jin Young
JY
Ahn
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Je Eun
JE
Song
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Min Hyung
MH
Kim
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Heun
H
Choi
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Jae Kyung
JK
Kim
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Hea Won
HW
Ann
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Jung Ho
JH
Kim
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Yongduk
Y
Jeon
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Su Jin
SJ
Jeong
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Sun Bean
SB
Kim
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea; AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Nam Su
NS
Ku
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea; AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Sang Hoon
SH
Han
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea; AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Young Goo
YG
Song
Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea.
Dongeun
D
Yong
Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea.
Kyungwon
K
Lee
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea; AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea.
June Myung
JM
Kim
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea; AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea. Electronic address: seran@yuhs.ac.
Jun Yong
JY
Choi
D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D015780:Carbapenems / Q000494:pharmacology* / Q000627:therapeutic use; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004926:Escherichia coli / Q000187:drug effects*; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use; D006801:Humans; D007902:Length of Stay; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D018440:beta-Lactam Resistance
D000900:Anti-Bacterial Agents; D015780:Carbapenems; D024841:Fluoroquinolones
Antibiotic selective pressure; Carbapenem resistance