BACKGROUND: Hospitalized carriers of carbapenem-resistant Enterobacteriaceae (CRE) are cohorted under contact precautions, including in the days between rehospitalization and surveillance culture results. This study investigates duration of CRE carriage to define populations requiring precautions upon readmission. METHODS: Patients with CRE-positive culture during 2009-2010 were followed up by rectal swab cultures taken retrospectively and prospectively for the study or as part of clinical follow-up. RESULTS: One hundred thirty-seven patients met the inclusion criteria, with follow-up cultures obtained from 97. Mean time to CRE negativity was 387 days (95% confidence interval: 312-463). Seventy-eight percent of patients (64/82) had positive culture at 3 months, 65% (38/58) at 6 months, and 39% (12/30) at 1 year. Duration of carriage was affected by repeat hospitalization (P = .001) and clinical, as opposed to surveillance, culture (P = .002). CONCLUSION: CRE carriers from a previous hospitalization have a lower probability of CRE carriage upon readmission if the index specimen was a surveillance culture and 1 year passed without further hospitalization. Multiple hospitalizations and CRE disease extend duration of carriage. This study better defines patients requiring cohorting and isolation, thus limiting spread of CRE and allowing for improved allocation of infection control measures.
BACKGROUND: Hospitalized carriers of carbapenem-resistant Enterobacteriaceae (CRE) are cohorted under contact precautions, including in the days between rehospitalization and surveillance culture results. This study investigates duration of CRE carriage to define populations requiring precautions upon readmission. METHODS:Patients with CRE-positive culture during 2009-2010 were followed up by rectal swab cultures taken retrospectively and prospectively for the study or as part of clinical follow-up. RESULTS: One hundred thirty-seven patients met the inclusion criteria, with follow-up cultures obtained from 97. Mean time to CRE negativity was 387 days (95% confidence interval: 312-463). Seventy-eight percent of patients (64/82) had positive culture at 3 months, 65% (38/58) at 6 months, and 39% (12/30) at 1 year. Duration of carriage was affected by repeat hospitalization (P = .001) and clinical, as opposed to surveillance, culture (P = .002). CONCLUSION: CRE carriers from a previous hospitalization have a lower probability of CRE carriage upon readmission if the index specimen was a surveillance culture and 1 year passed without further hospitalization. Multiple hospitalizations and CRE disease extend duration of carriage. This study better defines patients requiring cohorting and isolation, thus limiting spread of CRE and allowing for improved allocation of infection control measures.
Authors: L Lapointe-Shaw; T Voruganti; P Kohler; H-H Thein; B Sander; A McGeer Journal: Eur J Clin Microbiol Infect Dis Date: 2017-01-11 Impact factor: 3.267
Authors: Gustavo C Cerqueira; Ashlee M Earl; Christoph M Ernst; Yonatan H Grad; John P Dekker; Michael Feldgarden; Sinéad B Chapman; João L Reis-Cunha; Terrance P Shea; Sarah Young; Qiandong Zeng; Mary L Delaney; Diane Kim; Ellena M Peterson; Thomas F O'Brien; Mary Jane Ferraro; David C Hooper; Susan S Huang; James E Kirby; Andrew B Onderdonk; Bruce W Birren; Deborah T Hung; Lisa A Cosimi; Jennifer R Wortman; Cheryl I Murphy; William P Hanage Journal: Proc Natl Acad Sci U S A Date: 2017-01-17 Impact factor: 11.205
Authors: Sarah M Bartsch; Susan S Huang; Kim F Wong; Rachel B Slayton; James A McKinnell; Daniel F Sahm; Krystyna Kazmierczak; Leslie E Mueller; John A Jernigan; Bruce Y Lee Journal: J Clin Microbiol Date: 2016-08-31 Impact factor: 5.948
Authors: Carlo Tascini; Francesco Sbrana; Sarah Flammini; Enrico Tagliaferri; Fabio Arena; Alessandro Leonildi; Ilaria Ciullo; Francesco Amadori; Antonello Di Paolo; Andrea Ripoli; Russell Lewis; Gian Maria Rossolini; Francesco Menichetti Journal: Antimicrob Agents Chemother Date: 2014-01-13 Impact factor: 5.191
Authors: Julia A Messina; Eric Cober; Sandra S Richter; Federico Perez; Robert A Salata; Robert C Kalayjian; Richard R Watkins; Nikole M Scalera; Yohei Doi; Keith S Kaye; Scott Evans; Robert A Bonomo; Vance G Fowler; David van Duin Journal: Infect Control Hosp Epidemiol Date: 2015-12-21 Impact factor: 3.254