Risk factors of carbapenem-resistant enterobacteriaceae infection


  • Benjawan Comhangpol Master of Public Health, Faculty of Public Health, Kasetsart University, Chalermphrakiat Sakonnakhon Province Campus
  • Anusak Kerdsin Faculty of Public Health, Kasetsart University, Chalermphrakiat Sakonnakhon Province Campus
  • Peechanika Chopjitt Faculty of Public Health, Kasetsart University, Chalermphrakiat Sakonnakhon Province Campus
  • Chacrit knankhaeng Faculty of Public Health, Kasetsart University, Chalermphrakiat Sakonnakhon Province Campus


Nosocomial infection, carbapenem-resistant Enterobacterales, Enterobacteriaceae


This Study to determine risk factor associated with carbapenem-resistant Enterobacteriaceae (CRE) in patients who admitted at Roi Et hospital. The objective of this study was to investigate risk factors of Carbapenem-Resistant Enterobacterales(CRE) infection in patients at Roi Et hospital.

Method: Study design was case-control by divide into CRE-infected patients (case; n=192), carbapenem-susceptible Enterobacteriaceae (CSE) infected patients (control; n=192). Data of these patients were collected during January 1-December 31, 2018.  

Result: the study revealed that most of patients in case group was male (57.3%) and age- mean of 62-year-old (SD=16.67), hospitalization more than 7 days (54.7%). Both control group showed (65.1%), age-mean of 64-year-old (S.D.=13.42), and hospitalization more than 7days (59.9%), respectively. Analysis comparison among case and control group demonstrated that male (ORAdj=2.35, 95%CI=1.76-3.14), age >60 year-old (ORAdj=2.35,95%CI =1.76-3.14), hospitalization >7 days (ORA dj=2.00,95%CI=1.50-2.66), received carbapenem before admit (ORAdj=3.31, 95%CI =2.46-4.46), received carbapenem during hospitalization (ORAdj=3.69, 95%CI=2.74-4.98), blood received (ORAdj= 2.52,95%CI= 1.88-3.38), ventilation association (ORAdj=2.64, 95%CI=1.97-3.54), ventilation used >7days (ORAdj=3.38,95%CI=2.43-4.71), surgery (ORAdj=2.20;95%CI:1.61-3.02), intravenous injection (ORAdj=4.19;95%CI:3.10-5.66), and >7 days (ORAdj =3.50;95% CI:2.53-4.86), utilization of urinary catheter (ORAdj=2.26,95%CI=1.68-3.02), and>7days (ORAdj=3.60,95%CI =2.57-5.05) were the risk factors of CRE infection. 

            Conclusions: This study found out that risk factors of CRE infection were Carbapenems treatment, underwent with ventilation, catheterization, blood transfusion, surgery, Central Venous Catheter, and utilization of urinary catheter.


Ambler, R. P. (1980). The structure of beta-lactamases. Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences, 289(1036), 321–331. https://doi.org/10.1098/rstb.1980.0049

Baran, I., & Aksu, N. (2016). Phenotypic and genotypic characteristics of carbapenem-resistant Enterobacteriaceae in a tertiary-level reference hospital in Turkey. Annals of Clinical Microbiology and Antimicrobials, 15, 20. https://doi.org/10.1186/s12941-016-0136-2

Bush, K., & Fisher, J. F. (2011). Epidemiological expansion, structural studies, and clinical challenges of new β-lactamases from gram-negative bacteria. Annual Review of Microbiology, 65, 455–478. https://doi.org/10.1146/annurev-micro-090110-102911

Demir, Y., Zer, Y., & Karaoglan, I. (2015). Investigation of VIM, IMP, NDM-1, KPC AND OXA-48 enzymes in Enterobacteriaceae strains. Pakistan Journal of Pharmaceutical Sciences, 28(3 Suppl), 1127–1133.

Dhar, S., Martin, E. T., Lephart, P. R., McRoberts, J. P., Chopra, T., Burger, T. T., Tal-Jasper, R., Hayakawa, K., Ofer-Friedman, H., Lazarovitch, T., Zaidenstein, R., Perez, F., Bonomo, R. A., Kaye, K. S., & Marchaim, D. (2016). Risk Factors and Outcomes for Carbapenem-Resistant Klebsiella pneumoniae Isolation, Stratified by Its Multilocus Sequence Typing: ST258 Versus Non-ST258. Open Forum Infectious Diseases, 3(1), ofv213. https://doi.org/10.1093/ofid/ofv213

Doyle, D., Peirano, G., Lascols, C., Lloyd, T., Church, D. L., & Pitout, J. D. D. (2012). Laboratory Detection of Enterobacteriaceae That Produce Carbapenemases. Journal of Clinical Microbiology, 50(12), 3877–3880. https://doi.org/10.1128/JCM.02117-12

Guh, A. Y., Bulens, S. N., Mu, Y., Jacob, J. T., Reno, J., Scott, J., Wilson, L. E., Vaeth, E., Lynfield, R., Shaw, K. M., Vagnone, P. M. S., Bamberg, W. M., Janelle, S. J., Dumyati, G., Concannon, C., Beldavs, Z., Cunningham, M., Cassidy, P. M., Phipps, E. C., … Kallen, A. J. (2015). Epidemiology of Carbapenem-Resistant Enterobacteriaceae in 7 US Communities, 2012-2013. JAMA, 314(14), 1479–1487. https://doi.org/10.1001/jama.2015.12480

Hammoudi, D., Moubareck, C. A., Kanso, A., Nordmann, P., & Sarkis, D. K. (2015). SURVEILLANCE of CARBAPENEM NON-SUSCEPTIBLE GRAM NEGATIVE STRAINS and CHARACTERIZATION of CARBAPENEMASES of CLASSES A, B and D in a LEBANESE HOSPITAL. Le Journal Medical Libanais. The Lebanese Medical Journal, 63(2), 66–73. https://doi.org/10.12816/0012553

Hamzan, N. I., Yean, C. Y., Rahman, R. A., Hasan, H., & Rahman, Z. A. (2015). Detection of blaIMP4 and blaNDM1 harboring Klebsiella pneumoniae isolates in a university hospital in Malaysia. Emerging Health Threats Journal, 8, 10.3402/ehtj.v8.26011. https://doi.org/10.3402/ehtj.v8.26011

Karabay, O., Altindis, M., Koroglu, M., Karatuna, O., Aydemir, Ö. A., & Erdem, A. F. (2016). The carbapenem-resistant Enterobacteriaceae threat is growing: NDM-1 epidemic at a training hospital in Turkey. Annals of Clinical Microbiology and Antimicrobials, 15, 6. https://doi.org/10.1186/s12941-016-0118-4

Logan, L. K., & Weinstein, R. A. (2017). The Epidemiology of Carbapenem-Resistant Enterobacteriaceae: The Impact and Evolution of a Global Menace. The Journal of Infectious Diseases, 215(Suppl 1), S28–S36. https://doi.org/10.1093/infdis/jiw282

Nordmann, P., Cuzon, G., & Naas, T. (2009). The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. The Lancet. Infectious Diseases, 9(4), 228–236. https://doi.org/10.1016/S1473-3099(09)70054-4

Nordmann, P., Naas, T., & Poirel, L. (2011). Global spread of Carbapenemase-producing Enterobacteriaceae. Emerging Infectious Diseases, 17(10), 1791–1798. https://doi.org/10.3201/eid1710.110655

Patel, G., & Bonomo, R. A. (2013). “Stormy waters ahead”: Global emergence of carbapenemases. Frontiers in Microbiology, 4, 48. https://doi.org/10.3389/fmicb.2013.00048

Schwaber, M. J., & Carmeli, Y. (2008). Carbapenem-resistant Enterobacteriaceae: A potential threat. JAMA, 300(24), 2911–2913. https://doi.org/10.1001/jama.2008.896

Siegel, J. D., Rhinehart, E., Jackson, M., & Chiarello, L. (2007). 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. American Journal of Infection Control, 35(10), S65–S164. https://doi.org/10.1016/j.ajic.2007.10.007

Thomson, J. M., & Bonomo, R. A. (2005). The threat of antibiotic resistance in Gram-negative pathogenic bacteria: Beta-lactams in peril. Current Opinion in Microbiology, 8(5), 518–524. https://doi.org/10.1016/j.mib.2005.08.014

van Duin, D., & Doi, Y. (2017). The global epidemiology of carbapenemase-producing Enterobacteriaceae. Virulence, 8(4), 460–469. https://doi.org/10.1080/21505594.2016.1222343

van Duin, D., Perez, F., Rudin, S. D., Cober, E., Hanrahan, J., Ziegler, J., Webber, R., Fox, J., Mason, P., Richter, S. S., Cline, M., Hall, G. S., Kaye, K. S., Jacobs, M. R., Kalayjian, R. C., Salata, R. A., Segre, J. A., Conlan, S., Evans, S., … Bonomo, R. A. (2014). Surveillance of Carbapenem-Resistant Klebsiella pneumoniae: Tracking Molecular Epidemiology and Outcomes through a Regional Network. Antimicrobial Agents and Chemotherapy, 58(7), 4035–4041. https://doi.org/10.1128/AAC.02636-14

Wang, J.-T., Wu, U.-I., Lauderdale, T.-L. Y., Chen, M.-C., Li, S.-Y., Hsu, L.-Y., & Chang, S.-C. (2015). Carbapenem-Nonsusceptible Enterobacteriaceae in Taiwan. PLoS ONE, 10(3), e0121668. https://doi.org/10.1371/journal.pone.0121668

Wang, X., Chen, G., Wu, X., Wang, L., Cai, J., Chan, E. W., Chen, S., & Zhang, R. (2015). Increased prevalence of carbapenem resistant Enterobacteriaceae in hospital setting due to cross-species transmission of the blaNDM-1 element and clonal spread of progenitor resistant strains. Frontiers in Microbiology, 6, 595. https://doi.org/10.3389/fmicb.2015.00595




How to Cite

Comhangpol, B., Kerdsin, A. ., Chopjitt, P., & knankhaeng, C. . (2022). Risk factors of carbapenem-resistant enterobacteriaceae infection. UBRU Journal for Public Health Research, 11(2), 79–89. Retrieved from https://he02.tci-thaijo.org/index.php/ubruphjou/article/view/254654