Incidence and Factors Associated with Carbapenem-resistant Enterobacteriaceae and Vancomycin-resistant Enterococci in Rajavithi Hospital

Abstract

Background: Drug-resistant bacterial infection of Carbapenem-resistant Enterobacteriaceae (CRE) and Vancomycin-resistant Enterococci (VRE) is a worldwide problem. The severity of this issue has been increasing, thus, it affects patients and healthcare staff both in hospitals and local communities. Objectives: To evaluate the incidence of CRE and VRE infection, and to study factors related to the occurrence of CRE and VRE. Methods: A retrospective cohort study research method was conducted in a sample group of 495 patients diagnosed with an infection of CRE or VRE in the fiscal year of 2019. The data analysis was done via descriptive statistics, poisson regression analysis, and identification of factors related to CRE and VRE occurrence. This study is ethically accepted by the Research Ethics Committee, Rajavithi Hospital. Results: This study found that among 495 patients of the sample group, 418 were infected with CRE-which were Hospital acquired infection (HAI), Community acquired infection (CAI), and colonization infections of 12, 28.8, and 10.4 events per 1,000 days of hospital stay respectively. The remaining 77 VRE-infected patients were categorized into HAI, CAI, and colonization infections of 2.1, 4.9, and 2.9 events per 1,000 days of hospital stay, respectively. The most common sites of CRE infection were the urinary tract (24.9%), the respiratory tract (22.7%), and the urinary tract with a retained urinary catheter (17.1%). As for VRE, the most common sites of infection were the urinary tract (41.9%), the urinary tract with a retained urinary catheter, ventilator-associated pneumonia, and skin infection - with the same percentage of 12.9. The most prevalent CRE species were Kleb. pneumoniae, E.coli, and E. cloacae, with the percentage of 70.7, 21.2, and 4.8, respectively. The most prevalent species of VRE, on the other hand, is E. faecium, being 100 percent in total. 51.3 percent of the patients are male, and 64 percent of the patients are 60 years old or older. Statistically significant factors related to drug-resistant bacterial infection (CRE and VRE) found in Rajavithi Hospital are patients whose first diagnosis before admission is Immunocompromise (RR 1.65; 95% CI: 1.09 to 2.50; p=0.019), and patients admitted in surgical ward (RR 1.58; 95% CI: 1.01 to 2.49; p=0.048).  Conclusion: Incidence of CRE and VRE infection at Rajavithi Hospital is 12 and 2.1 times per 1,000 days of hospital stay, respectively. Factors such as sex, age, underlying diseases, severity of symptoms before admission, and discharge status, are not significantly different between CRE and VRE groups. However, associated factors that show statistically significant difference between these two groups are first diagnosis before admission and hospital wards. Thus, medical staff should have policies about continuous infection surveillance, prevention and control of the spreading of drug-resistant bacterial infection.