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Published on: March 3, 2023
Risk factors associated with carbapenem-resistant Enterobacterales infections in hospitalized patients: A
Vivian Zambrano-Calderero1, Fabricio Vera-Álava2, Marcio Borges3
1Faculty of Health Sciences, Universidad Laica Eloy Alfaro de Manabí, Manta, Ecuador.
Background:
Carbapenem-Resistant Enterobacterales (CRE) represent a critical public health threat. Aim: To analyze risk factors for CRE infections in adults at a secondary hospital in Manta, Ecuador, during 2022.
Methodology:
A case-control study (27 cases; 193 controls) compared CRE versus Carbapenem-Susceptible Enterobacterales (CSE). Univariable and Multivariable Firth logistic regression was performed to adjust for small-sample bias.
Results:
In multivariable analysis, time to infection onset was the most consistent predictor of CRE (aOR: 1.08; 95% CI: 1.03-1.12; p=0.001). Other significant risk factors included chronic corticosteroid therapy (aOR: 43.10; 95% CI: 3.04-611.96; p=0.005), prior hospitalization (aOR: 14.52; 95% CI: 2.22-94.86; p=0.005), urinary catheter (aOR: 10.39; 95% CI: 2.20-49.00; p=0.003) and central venous catheterization (aOR: 13.46; 95% CI: 1.29-139.45; p=0.029). Nosocomial origin (aOR: 0.05; 95% CI: 0.003-0.86; p=0.039), and Internal Medicine management (aOR: 0.23; 95% CI: 0.06-0.94; p=0.041) showed protective associations.
Conclusions:
In this setting, the cumulative duration of healthcare exposure (time to infection onset) was the primary driver of CRE risk. However, these risk factors are highly context-dependent and vary across different populations and facilities. Therefore, these results cannot be generalized, highlighting the need for localized surveillance and further multicenter studies to understand regional resistance dynamics.
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