Risk Factors in Carbapenem Resistant Enterobacteriaceae Infections

Carbapenem resistance, which was rarely observed up until the recent years, is becoming increasingly more common among the Enterobacteriaceae family around the world. It is thought that specifying the risk factors for carbapenem-resistant Enterobacteriaceae (CRE) infections may be helpful to initiate the appropriate empirical therapy at an early phase and to take the infection control measures. The aim of this study is to observe the risk factors and their relationship with mortality in patients infected with CRE. The control group was randomly selected from amongst the patients who were admitted to the same ward with the patient group during the period when CRE growth was observed, but were tested negative for CRE growth. Two control subjects were enrolled for each patient. Seventy patients where CRE growth was observed were included in the study. Among these patients, 55 were infected with K.pneumoniae, 7 with E.coli, 6 with Enterobacter cloacae, 1 with Enterobacter asburiae and one patient was infected with Enterobacter aerogenes. Immunosuppression, endotracheal intubation, mechanical ventilation, urinary neumoniadesn, total parenteral nutrition (TPN)_, central venous catheter (CVC), tracheostomy, urinary catheter days before CRE, endotracheal intubation days, ventilator-days, CVC days, TPN days, days of nasogastric intubation, days of abdominal drain were found to be statistically significant. Also, the number of days spent in intensive care before CRE developed, the Acute Physiology And Chronic Health Evaluation II (APACHE II) score; and days of piperacillin/tazobactam, carbapenem, Colistin, and neumoniades use were found to be significant. In order to reduce the infections that happen due to CRE, the surveillance results should be continuously monitored and the recommendations of the infection control committee should be taken under consideration. The indication of invasive procedures should procedures be well-defined and unnecessary invasive procedures should be avoided. In patients who will receive therapy, treatment should be initiated according to the rational antibiotic use principle.