Factors Associated with Carbapenem-resistant Escherichia Coli Infection and the Results of Carbapenems Antimicrobial Stewardship Program
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Nov 21, 2019
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Abstract
The purpose of this study aimed to investigate factors associated with Carbapenemsresistant Escherichia coli (CRE-E.coli) infection and the outcome of Antimicrobial Stewardship Program of carbapenems drug groups among patients at Roi Et Hospital. This study was hospital based Unmatched case-control study. All data were retrieved from medical records of admitted patients at Roi Et Hospital between January 1st, 2017 to December 31st, 2018. The Antimicrobial Stewardship Program (ASP) of carbapenems drug groups was collected data from medical records of patient before and after receives program and collected May 1st, to December 31st, 2017. The statistical analyses were used descriptive statistics, univariate analysis and multivariate analysis by multiple logistic regressions. It shows that of 150 cases with CRE-E.coli infection most of them were male 66.67%, mean age 57.28 years (SD = 16.49), admitted at Intensive care unit 40.91%. And 300 controls were non-CRE-E.coli infection, most of them were male 50.00%, mean age 60.68 years (SD = 16.85). After analysis were found patients underwent with endotracheal tube (ORAdj = 4.37; 95%CI = 2.84-6.71), mechanical ventilator (ORAdj = 1.92; 95%CI =1.28-2.95), and carbamenems used (ORAdj = 3.06; 95%CI = 2.03-4.61) were important risk factors for CRE-E.coli infection. After ASP was found appropriated proportion of medical order was increases from 80.70 % to 93.60 %, changed plan followed pharmacist recommendation 90.01 %, and cost of carbapenems after ASP was decreases 77,000 Baht. In conclusion, this study revealed that patients underwent with invasive medical devices including endotracheal tube, mechanical ventilator and carbapenems used were important risk factors for CRE-E.coli infection. The outcome of ASP by pharmacist recommendation were found the appropriate proportion of carbapenems medical order was increase, doctors has changed plan followed recommendation, and costs of carbapenems used after ASP was decreases.
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1.
Putthanachote N, Kasemsup P, Sangsa N. Factors Associated with Carbapenem-resistant Escherichia Coli Infection and the Results of Carbapenems Antimicrobial Stewardship Program. Health Sci J Thai [Internet]. 2019 Nov. 21 [cited 2024 Apr. 25];1(2):8-19. Available from: https://he02.tci-thaijo.org/index.php/HSJT/article/view/219113
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References
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Fecal Samples of Inpatients of Beijing Tongren Hospital. Jpn J Infect Dis 2017; 70(3): 290–294.
26. Arslan H, Azap OK, Ergönül O, Timurkaynak F, Urinary Tract Infection Study Group. Risk factors for ciprofloxacin
resistance among Escherichia coli strains isolated from community-acquired urinary tract infections in Turkey.
J Antimicrob Chemother 2005; 56(5): 914–918.
27. Calbo E, Romaní V, Xercavins M, Gómez L, Vidal CG, Quintana S, et al. Risk factors for community-onset
urinary tract infections due to Escherichia coli harbouring extended-spectrum beta-lactamases. J Antimicrob Chemother 2006; 57(4): 780–783.
28. Guanghui Z, Jing L, Guojun Z, Hong L. Epidemiology and risk factors of neuro-surgical bacterial meningitis /
encephalitis induced by carbapenem resistant Entero-bacteriaceae. J Infect Chemother Off J Jpn Soc Chemother 2019; 21: 256-267.
29. Wang Q, Zhang Y, Yao X, Xian H, Liu Y, Li H, et al. Risk factors and clinical outcomes for carbapenemresistant
Enterobacteriaceae nosocomial infections. Eur J Clin Microbiol Infect Dis Off Publ Eur Soc Clin Microbiol 2016; 35(10): 1679–1689.
30. Ananwattanakit, M., Usayaporn,S., Tantawi-chien, T., Puttilerpong, C., Pengsuparp, T. Effects of Pharmacist
Participation in an Antimicrobial Stewardship Program on Appropriate Antibiotic Use. Thai Pharm Health Sci
J 2015; 10(1): 1–9. [in Thai]
31. Xu YL, Hu LM, Xie ZZ, Dong YW, Dong L. Impact of antimicrobial stewardship program on antimicrobial usage and detection rate of multidrug-resistant gram-negative bacteria. Zhonghua Er Ke Za Zhi Chin J Pediatr 2019;
57(7): 553–558.
32. García-Rodríguez JF, Bardán-García B, Peña-Rodríguez MF, Álvarez-Díaz H, Mariño-Callejo A. Meropenem
antimicrobial stewardship program: clinical, economic, and antibiotic resistance impact. Eur J Clin Microbiol
Infect Dis Off Publ Eur Soc Clin Microbiol 2019; 38(1): 161–170
Thangphaet 2005; 88 Suppl 10: S1-9.
2. Danchaivijitr S, Judaeng T, Sripalakij S, Naksawas K, Plipat T. Prevalence of nosocomial infection in Thailand 2006. J Med Assoc Thail Chotmaihet Thangphaet 2007; 90(8): 1524–1529.
3. Rosenthal VD, Bijie H, Maki DG, Mehta Y, Apisarnthanarak A, Medeiros EA, et al. International Nosocomial
Infection Control Consortium (INICC) report, data summary of 36 countries, for 2004-2009. Am J Infect Control 2012;40(5): 396–407.
4. Li X, Chen Y, Gao W, Ye H, Shen Z, Wen Z, et al. A 6-year study of complicated urinary tract infections in southern China: prevalence, antibiotic resistance, clinical and economic outcomes. Ther Clin Risk Manag 2017; 13: 1479–1487.
5. Curran KG, Heiman Marshall KE, Singh T, Doobovsky Z, Hensley J, Melius B, et al. An outbreak of Escherichia
coli O157:H7 infections following a dairy education school field trip in Washington state, 2015. Epidemiol Infect 2017; 22: 1–11.
6. Lochan H, Pillay V, Bamford C, Nuttall J, Eley B. Bloodstream infections at a tertiary level paediatric hospital in South Africa. BMC Infect Dis 2017; 17(1): 750.
7. Ukah UV, Glass M, Avery B, Daignault D, Mulvey MR, Reid-Smith RJ, et al. Risk factors for acquisition of multidrug-resistant Escherichia coli and development of community-acquired urinary tract infections. Epidemiol Infect 2017; 12:
1–12.
8. Peirano G, Gregson DB, Kuhn S, Vanderkooi OG, Nobrega DB, Pitout JDD. Rates of colon-ization with extended-spectrum β-lactamase-producing Escherichia coli in Canadian travellers returning from South Asia: a cross-sectional assessment. CMAJ Open 2017; 5(4): E850–855.
9. Lukuke HM, Kasamba E, Mahuridi A, Nlandu RN, Narufumi S, Mukengeshayi AN, et al. Nosocomial urinary tract and surgical site infection rates in the Maternity Ward at the General Referral Hospital in Katuba, Lubumbashi, Democratic Republic of the Congo. Pan Afr Med J 2017; 28: 57.
10. Kotagiri P, Chembolli D, Ryan J, Hughes PD, Toussaint ND. Urinary Tract Infections in the First Year Post-Kidney
Transplantation: Potential Benefits of Treating Asymptomatic Bacteriuria. Transplant Proc 2017; 49(9): 2070–2075.
11. Ismail MD, Ali I, Hatt S, Salzman EA, Cronen-wett AW, Marrs CF, et al. Association of Escherichia coli ST131 Lineage with risk of Urinary Tract Infection Recurrence among young women. J Glob Antimicrob Resist 2017;
16: 215-230.
12. Zhang M, Xu Y, Jiang Z, Qian J, Zhang Z, Sun N, et al. Study on risk factor of central venous catheter infection in ICU: 1 160 patients report. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2017; 29(12): 1082–1086.
13. Chapelet G, Boureau AS, Dylis A, Herbreteau G, Corvec S, Batard E, et al. Association between dementia and reduced walking ability and 30-day mortality in patients with extended-spectrum betalactamase-producing Escherichia coli bacteremia. Eur J Clin Micro-biol Infect Dis Off Publ Eur Soc Clin Microbiol 2017; 36(12): 2417–2422.
14. Meng X, Liu S, Duan J, Huang X, Zhou P, Xiong X, et al. Risk factors and medical costs for healtcare associated carbapenem-resistant Escherichia coli infection among hospitalized patients in a Chinese teaching hospital. BMC Infect Dis 2017; 17(1): 82.
15. Rosenthal VD, Maki DG, Mehta Y, Leblebi-cioglu H, Memish ZA, Al-Mousa HH, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary of 43 countries for 2007-2012. Device associated module. Am J Infect Control 2014; 42(9): 942–56.
16. Rizzo K, Horwich-Scholefield S, Epson E. Carbapenem and Cephalosporin Resistance among Enterobacteriaceae
in Healthcare-Associated Infections, California, USA1. Emerg Infect Dis 2019; 25(7): 1389–1393.
17. Ruh E, Zakka J, Hoti K, Fekrat A, Guler E, Gazi U, et al. Extended-spectrum β-lactamase, plasmidmediated
AmpC β-lactamase, fluoroquinolone resistance, and decreased susceptibility to carbapenems in Enterobacteriaceae:
fecal carriage rates and associated risk factors in the community of Northern Cyprus. Antimicrob Resist Infect Control 2019; 8: 98.
18. Zhang Y, Wang Q, Yin Y, Chen H, Jin L, Gu B, et al. Epidemiology of Carbapenem-Resistant Enterobacteriaceae
Infections: Report from the China CRE Network. Antimicrob Agents Chemother 2018; 62(2): 216-236.
19. Namikawa H, Yamada K, Fujimoto H, Oinuma K-I, Tochino Y, Takemoto Y, et al. Clinical Characteristics of Bacteremia Caused by Extended-spectrum Betalactamase-producing Escherichia coli at a Tertiary Hospital. Intern Med Tokyo Jpn 2017; 56(14): 1807–1815.
20. Nisha KV, Veena SA, Rathika SD, Vijaya SM, Avinash SK. Antimicrobial susceptibility, risk factors and prevalence of bla cefotaximase, temoneira, and sulfhydryl variable genes among Escherichia coli in community-acquired pediatric urinary tract infection. J Lab Physicians 2017; 9(3): 156–162.
21. Gao B, Li X, Yang F, Chen W, Zhao Y, Bai G, et al. Molecular Epidemiology and Risk Factors of Ventilator-Associated Pneumonia Infection Caused by Carbapenem-Resistant Enterobacteriaceae. Front Pharmacol 2019; 10: 262.
22. Søgaard M, Heide-Jørgensen U, Vandenbro-ucke JP, Schønheyder HC, Vandenbroucke-Grauls CMJE. Risk
factors for extended-spectrum β-lactamase-producing Escheri-chia coli urinary tract infection in the community
in Denmark: a case-control study. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis 2017; 23(12): 952–960.
23. Patel HB, Lusk KA, Cota JM. The Role of Cefepime in the Treatment of Extended-Spectrum Beta-Lactamase
Infections. J Pharm Pract. 2017 Jan 1; 897190017743134.
24. Pouladfar G, Basiratnia M, Anvarinejad M, Abbasi P, Amirmoezi F, Zare S. The antibiotic susceptibility patterns of uropathogens among children with urinary tract infection in Shiraz. Medicine (Baltimore) 2017; 96(37): e7834.
25. Xu M, Fan Y, Wang M, Lu X. Characteristics of Extended Spectrum β-Lactamases-Producing Escherichia coli in
Fecal Samples of Inpatients of Beijing Tongren Hospital. Jpn J Infect Dis 2017; 70(3): 290–294.
26. Arslan H, Azap OK, Ergönül O, Timurkaynak F, Urinary Tract Infection Study Group. Risk factors for ciprofloxacin
resistance among Escherichia coli strains isolated from community-acquired urinary tract infections in Turkey.
J Antimicrob Chemother 2005; 56(5): 914–918.
27. Calbo E, Romaní V, Xercavins M, Gómez L, Vidal CG, Quintana S, et al. Risk factors for community-onset
urinary tract infections due to Escherichia coli harbouring extended-spectrum beta-lactamases. J Antimicrob Chemother 2006; 57(4): 780–783.
28. Guanghui Z, Jing L, Guojun Z, Hong L. Epidemiology and risk factors of neuro-surgical bacterial meningitis /
encephalitis induced by carbapenem resistant Entero-bacteriaceae. J Infect Chemother Off J Jpn Soc Chemother 2019; 21: 256-267.
29. Wang Q, Zhang Y, Yao X, Xian H, Liu Y, Li H, et al. Risk factors and clinical outcomes for carbapenemresistant
Enterobacteriaceae nosocomial infections. Eur J Clin Microbiol Infect Dis Off Publ Eur Soc Clin Microbiol 2016; 35(10): 1679–1689.
30. Ananwattanakit, M., Usayaporn,S., Tantawi-chien, T., Puttilerpong, C., Pengsuparp, T. Effects of Pharmacist
Participation in an Antimicrobial Stewardship Program on Appropriate Antibiotic Use. Thai Pharm Health Sci
J 2015; 10(1): 1–9. [in Thai]
31. Xu YL, Hu LM, Xie ZZ, Dong YW, Dong L. Impact of antimicrobial stewardship program on antimicrobial usage and detection rate of multidrug-resistant gram-negative bacteria. Zhonghua Er Ke Za Zhi Chin J Pediatr 2019;
57(7): 553–558.
32. García-Rodríguez JF, Bardán-García B, Peña-Rodríguez MF, Álvarez-Díaz H, Mariño-Callejo A. Meropenem
antimicrobial stewardship program: clinical, economic, and antibiotic resistance impact. Eur J Clin Microbiol
Infect Dis Off Publ Eur Soc Clin Microbiol 2019; 38(1): 161–170