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Predictors of Persistent Carbapenem-Resistant Enterobacteriaceae Carriage upon Readmission and Score Development
Pnina Ciobotaro1, Natalie Flaks-Manov2, Maly Oved1
11Infectious Diseases Unit,Kaplan Medical Center,Rehovot,Israel.
Insights
Carbapenem-resistant Enterobacteriaceae (CRE) carriage often persists upon hospital readmission. A new score predicts persistent CRE carriage risk, aiding infection control for patients with CRE.
Area of Science:
- Infectious Diseases
- Epidemiology
- Healthcare Management
Background:
- Carbapenem-resistant Enterobacteriaceae (CRE) carriage is a significant concern, particularly upon hospital readmission, leading to potential cross-transmission.
- Identifying predictors of persistent CRE carriage is crucial for effective patient management and infection control strategies.
Purpose of the Study:
- To identify predictors of persistent carbapenem-resistant Enterobacteriaceae (CRE) carriage upon hospital readmission.
- To develop a risk prediction score to stratify patients based on their likelihood of persistent CRE carriage.
Main Methods:
- Retrospective cohort study involving 168 CRE carriers and 474 readmissions at a university-affiliated hospital.
- Generalized estimating equations (GEE) multivariable model used to analyze predictors of persistent CRE carriage.
- Development and validation of a CRE readmission score to categorize risk into low, intermediate, and high groups.
Main Results:
- CRE carrier status persisted for one year in 33% of carriers, with 42.6% of readmissions showing positive CRE status.
- Key predictors of persistent CRE carriage included readmission within 1 month, positive CRE status on preceding admission, low Norton score, and diabetes mellitus.
- The derived CRE readmission score demonstrated strong discriminatory ability (C-statistics of 0.789 in derivation and 0.861 in validation sets), with carriage rates of 8.6%, 38.9%, and 77.6% for low, intermediate, and high-risk groups, respectively.
Conclusions:
- Persistent CRE carrier state is common upon hospital readmission.
- The developed CRE readmission score effectively estimates the risk of persistent carriage, informing targeted screening and infection control measures.
Background:
Carriers of carbapenem-resistant Enterobacteriaceae (CRE) are often readmitted, exposing patients to CRE cross-transmission. OBJECTIVE To identify predictors of persistent CRE carriage upon readmission, directing a risk prediction score.
Design:
Retrospective cohort study.
Setting:
University-affiliated general hospital.
Patients:
A cohort of 168 CRE carriers with 474 readmissions.
Methods:
The primary and secondary outcomes were CRE carriage status at readmission and length of CRE carriage. Predictors of persistent CRE carriage upon readmission were analyzed using a generalized estimating equations (GEE) multivariable model. Readmissions were randomly divided into derivation and validation sets. A CRE readmission score was derived to predict persistent CRE carriage in 3 risk groups: high, intermediate, and low. The discriminatory ability of the model and the score were expressed as C statistics.
Results:
CRE carrier status persisted for 1 year in 33% of CRE carriers. Positive CRE status was detected in 202 of 474 readmissions (42.6%). The following 4 variables were associated with persistent CRE carriage at readmission: readmission within 1 month (odds ratio [OR], 6.95; 95% confidence interval [CI], 2.79-17.30), positive CRE status on preceding admission (OR, 5.46; 95% CI, 3.06-9.75), low Norton score (OR, 3.07; 95% CI, 1.26-7.47), and diabetes mellitus (OR, 1.84; 95% CI, 0.98-3.44). The C statistics were 0.791 and 0.789 for the derivation set (n=322) model and score, respectively, and the C statistic was 0.861 for the validation set of the score (n=152). The rates of CRE carriage at readmissions (validation set) for the groups with low, intermediate, and high scores were 8.6%, 38.9%, and 77.6%, respectively.
Conclusions:
CRE carrier state commonly persists upon readmission, and this risk can be estimated to guide screening policy and infection control measures.
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