Adriana Jimenez1, Kristopher Fennie2, L Silvia Munoz-Price3, Boubakari Ibrahimou4, Vukosava Pekovic5, Lilian M Abbo6, Octavio Martinez7, Gemma Rosello8, Kathleen Sposato8, Yohei Doi9, Mary Jo Trepka5. 1. Department of Infection Prevention and Control, Jackson Health System, Miami, FL; Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL. Electronic address: adriana.jimenez@jhsmiami.org. 2. Division of Natural Sciences, New College of Florida, Sarasota, FL. 3. Department of Medicine, Division of Infectious Diseases, Medical College of Wisconsin Milwaukee, WI. 4. Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL. 5. Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL. 6. Department of Infection Prevention and Control, Jackson Health System, Miami, FL; Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL. 7. Department of Pathology and Laboratory Medicine, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL. 8. Department of Infection Prevention and Control, Jackson Health System, Miami, FL. 9. Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA; Departments of Microbiology and Infectious Diseases, Fujita Health University School of 14Medicine, Toyoake, Aichi, Japan.
Abstract
BACKGROUND: Current recommendations by the Centers for Disease Control and Prevention suggest placing patients with carbapenem-producing Enterobacteriales (CPE) in contact precautions, but there is no consensus on the appropriate duration of precautions. AIM: We aimed to evaluate predictors for prolonged CPE carriage and median clearance time. METHODS: Patients with first isolated CPE identified from 2012-2016 were followed for clearance of CPE using at least two rectal or tracheal aspirate surveillance cultures and clinical cultures during intensive-care-unit admission. Predictors associated with prolonged CPE carriage were assessed using Cox proportional-hazards. RESULTS: Out of 75 eligible patients, 25 (33%) cleared their CPE-carrier status; median time to clearance was 80 days (Range, 16-457). Patients who were immunocompromised, had mechanical ventilation exposure, or exposure to carbapenems had 66%, 66%, and 86% (HR, 0.34, 0.34, and 0.14, respectively [P-value <.05]) lower probability of clearing compared to those immunocompetent of without such exposures. Patients with CPE isolated from more than one body site had a 5.3 times higher probability of clearing their CPE-carrier status (P-value <.001). CONCLUSIONS: Patients immunocompromised, with mechanical ventilation exposure, or exposure to carbapenems had higher risk for prolonged CPE carriage. Infection prevention programs should consider these predictors as part of their assessment of discontinuing contact precautions among CPE carriers to prevent horizontal transmission and outbreaks within healthcare facilities.
BACKGROUND: Current recommendations by the Centers for Disease Control and Prevention suggest placing patients with carbapenem-producing Enterobacteriales (CPE) in contact precautions, but there is no consensus on the appropriate duration of precautions. AIM: We aimed to evaluate predictors for prolonged CPE carriage and median clearance time. METHODS:Patients with first isolated CPE identified from 2012-2016 were followed for clearance of CPE using at least two rectal or tracheal aspirate surveillance cultures and clinical cultures during intensive-care-unit admission. Predictors associated with prolonged CPE carriage were assessed using Cox proportional-hazards. RESULTS: Out of 75 eligible patients, 25 (33%) cleared their CPE-carrier status; median time to clearance was 80 days (Range, 16-457). Patients who were immunocompromised, had mechanical ventilation exposure, or exposure to carbapenems had 66%, 66%, and 86% (HR, 0.34, 0.34, and 0.14, respectively [P-value <.05]) lower probability of clearing compared to those immunocompetent of without such exposures. Patients with CPE isolated from more than one body site had a 5.3 times higher probability of clearing their CPE-carrier status (P-value <.001). CONCLUSIONS:Patients immunocompromised, with mechanical ventilation exposure, or exposure to carbapenems had higher risk for prolonged CPE carriage. Infection prevention programs should consider these predictors as part of their assessment of discontinuing contact precautions among CPE carriers to prevent horizontal transmission and outbreaks within healthcare facilities.