title: Risk factors for acquisition of carbapenem resistant Enterobacteriaceae in an acute tertiary care hospital in Singapore.
abstract: BACKGROUND
  Carbapenem resistant Enterobacteriaceae (CRE) is increasingly reported worldwide. A similar increase is seen in Singapore since identification of its first case in 2008. The aim of this study was to identify local risk factors for carriage of CRE in patients from an acute tertiary care hospital in Singapore.
  
  
  METHODS
  A matched case-control study was conducted on inpatients treated from January 1, 2011 till December 31, 2013. Two hundred and three cases of CRE infection or colonization were matched with 203 controls. CRE types were identified by PCR. Statistical analysis of data including a multivariate logistic regression analysis was done using SPSS 21.0.
  
  
  RESULTS
  CREs were commonly seen in Klebsiella pneumoniae (42.2 %), Escherichia coli (24.3 %) and Enterobacter cloacae complex (17.2 %) in the 268 isolates. NDM-1 was the commonest CRE type seen (44.4 %), followed by KPC (39.9 %) whilst OXA-48 only constituted (7.8 %). Univariate analysis identified key risk factors associated with CRE as history of previous overseas hospitalization (OR: 33.667; 95 % CI: 4.539-259.700), admission to ICU (OR: 11.899; 95 % CI: 4.986-28.399) and HD/ICA (OR: 6.557; 95 % CI: 4.057-10.596); whilst a multivariate analysis revealed exposure to antibiotics penicillin (OR: 4.640; 95 % CI: 1.529-14.079] and glycopeptide (OR: 5.162; 95 % CI: 1.377-19.346) and presence of central line device (OR: 3.117; 95 % CI: 1.167-8.330) as significant independent predictors.
  
  
  CONCLUSIONS
  The identification of risk factors amongst our local population helped to refine the criteria used for target active surveillance screening for CRE amongst inpatients at time of hospital admission.
authors.affiliation: Infection Control, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore.
authors.forename: Moi Lin
authors.initials: ML
authors.lastname: Ling
authors.affiliation: Infection Control, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore.
authors.forename: Yong Ming
authors.initials: YM
authors.lastname: Tee
authors.affiliation: Infection Control, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore.
authors.forename: Soong Geck
authors.initials: SG
authors.lastname: Tan
authors.affiliation: Infection Control, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore.
authors.forename: Ismawati M
authors.initials: IM
authors.lastname: Amin
authors.affiliation: Infection Control, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore.
authors.forename: Kue Bien
authors.initials: KB
authors.lastname: How
authors.affiliation: Infection Control, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore.
authors.forename: Kwee Yuen
authors.initials: KY
authors.lastname: Tan
authors.affiliation: Infection Control, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore.
authors.forename: Lai Chee
authors.initials: LC
authors.lastname: Lee
keywords: Carbapenem resistant; Enterobacteriaceae; Epidemiology; Risk factors