Increased Risk for Carbapenem-Resistant Enterobacteriaceae Colonization in Intensive Care Units after Hospitalization in Emergency Department. Salomão Matias Chiarastelli,Freire Maristela Pinheiro,Boszczowski Icaro,Raymundo Sueli F,Guedes Ana Rubia,Levin Anna S Emerging infectious diseases Carbapenem-resistant Enterobacteriaceae (CRE) colonization is common in hospital patients admitted to intensive care units (ICU) from the emergency department. We evaluated the effect of previous hospitalization in the emergency department on CRE colonization at ICU admission. Our case-control study included 103 cases and 201 controls; cases were patients colonized by CRE at admission to ICU and controls were patients admitted to ICU and not colonized. Risk factors were emergency department stay, use of carbapenem, Simplified Acute Physiology Score, upper digestive endoscopy, and transfer from another hospital. We found that ED stay before ICU admission was associated with CRE colonization at admission to the ICU. Our findings indicate that addressing infection control problems in EDs will help to control carbapenem resistance in ICUs. 10.3201/eid2606.190965

Development of a risk prediction model of carbapenem-resistant Enterobacteriaceae colonization among patients in intensive care units. Song Ju Yeon,Jeong Ihn Sook American journal of infection control BACKGROUND:Few hospitals have conducted surveillance cultures to identity carbapenem-resistant Enterobacteriaceae (CRE) colonization in Korea because of high test costs, long wait time to get results, and lack of personnel. This study aimed to identify risk factors of CRE colonization and to develop a model for predicting the risk of CRE colonization. METHODS:This retrospective cohort study was done with medical record review at a tertiary hospital between October 1, 2016, and October 31, 2017, in 444 adult patients admitted to the intensive care unit. The identification of risk factors and risk model development were done by multiple logistic regression. The area under the receiver operator characteristic curve and correct classification were measured. RESULTS:The risk prediction logistic model for CRE colonization was composed of 4 factors among 22 significant variables on univariate analysis and 1 interaction term; E (logit of CRE colonization) = -2.821 + 1.606 (isolation of multidrug-resistant organisms) + 1.347 (≥15 days of cephalosporin administration) + 0.980 (≥15 days of carbapenem administration) + 0.544 (score ≥21 on Acute Physiology and Chronic Health Evaluation II). The risk prediction model showed 0.80 (95% confidence interval, 0.74-0.85) for the area under the curve, and 68.9% correct classification. CONCLUSIONS:It is recommended to utilize the risk prediction model to screen out for the colonization of CRE, and to do validation studies for verifying the generalizability. 10.1016/j.ajic.2018.05.001

Screening for carbapenem-resistant Enterobacteriaceae: Who, When, and How? Richter Sandra S,Marchaim Dror Virulence The global spread of carbapenem-resistant Enterobacteriaceae (CRE) has been fostered by the lack of preemptive screening of patients in healthcare facilities that could prevent patient-to-patient transmission. Outbreaks of CRE infections have led some institutions to implement rigorous screening programs, although controlled comparative data are frequently lacking. Resource limitations and uncertainty regarding the optimal approach has kept many facilities from enacting more active routine surveillance policies that could reduce the prevalence of CRE. The ideal population to target for screening, the frequency of testing, and the preferred test method are components of surveillance programs that remain open to debate. This review discusses the rationale for different screening policies in use and the performance characteristics of laboratory methods available to detect CRE carriage. 10.1080/21505594.2016.1255381