Prevalence and risk factors of carbapenem-resistant Enterobacterales positivity by active screening in intensive care units in the Henan Province of China: A multi-center cross-sectional study

Bo Guo; Ziqi Guo; Huifeng Zhang; Chuanchuan Shi; Bingyu Qin; Shanmei Wang; Yinjiang Chang; Jian Chen; Peili Chen; Limin Guo; Weidong Guo; Huaibin Han; Lihong Han; Yandong Hu; Xiaoye Jin; Yening Li; Hong Liu; Ping Lou; Yibing Lu; Panfeng Ma; Yanhua Shan; Yiyi Sun; Wukui Zhang; Xisheng Zheng; Huanzhang Shao

doi:10.3389/fmicb.2022.894341

Prevalence and risk factors of carbapenem-resistant Enterobacterales positivity by active screening in intensive care units in the Henan Province of China: A multi-center cross-sectional study

Front Microbiol. 2022 Sep 14:13:894341. doi: 10.3389/fmicb.2022.894341. eCollection 2022.

Authors

Bo Guo^{1

2

3

4}, Ziqi Guo^{1

2

3

4}, Huifeng Zhang^{1

2

3

4}, Chuanchuan Shi^{1

2

3

4}, Bingyu Qin^{1

2

3

4}, Shanmei Wang⁵, Yinjiang Chang⁶, Jian Chen⁷, Peili Chen⁸, Limin Guo⁹, Weidong Guo^{10

11}, Huaibin Han¹², Lihong Han¹³, Yandong Hu¹⁴, Xiaoye Jin¹⁵, Yening Li¹⁶, Hong Liu¹⁷, Ping Lou¹⁸, Yibing Lu¹⁹, Panfeng Ma²⁰, Yanhua Shan²¹, Yiyi Sun²², Wukui Zhang²³, Xisheng Zheng²⁴, Huanzhang Shao^{1

2

3

4}

Affiliations

¹ Department of Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, China.
² Department of Critical Care Medicine, Henan University People's Hospital, Zhengzhou, China.
³ Henan Key Laboratory for Critical Care Medicine, Zhengzhou, China.
⁴ Department of Critical Care Medicine, Zhengzhou University People's Hospital, Zhengzhou, China.
⁵ Department of Microbiology Laboratory, Henan Provincial People's Hospital, Zhengzhou, China.
⁶ Department of Critical Care Medicine, Puyang People's Hospital, Puyang, China.
⁷ Department of Critical Care Medicine, Xuchang Central Hospital, Xuchang, China.
⁸ Department of Critical Care Medicine, Shangqiu People's Hospital, Shangqiu, China.
⁹ Department of Critical Care Medicine, Jiyuan People's Hospital, Jiyuan, China.
¹⁰ Department of Critical Care Medicine, Xinxiang Central Hospital, Xinxiang, China.
¹¹ Department of Critical Care Medicine, The Fourth Clinical College of Xinxiang Medical College, Xinxiang, China.
¹² Department of Critical Care Medicine, Zhoukou Central Hospital, Zhoukou, China.
¹³ Department of Critical Care Medicine, Luoyang Central Hospital, Luoyang, China.
¹⁴ Department of Critical Care Medicine, Sanmenxia Central Hospital, Sanmenxia, China.
¹⁵ Department of Critical Care Medicine, Kaifeng People's Hospital, Kaifeng, China.
¹⁶ Department of Critical Care Medicine, Luohe Central Hospital, Luohe, China.
¹⁷ Department of Critical Care Medicine, Pingdingshan First People's Hospital, Pingdingshan, China.
¹⁸ Department of Critical Care Medicine, Zhengzhou First People's Hospital, Zhengzhou, China.
¹⁹ Department of Critical Care Medicine, Xinyang Central Hospital, Xinyang, China.
²⁰ Department of Critical Care Medicine, Anyang People's Hospital, Anyang, China.
²¹ Department of Critical Care Medicine, Zhumadian Central Hospital, Zhumadian, China.
²² Department of Critical Care Medicine, Hebi People's Hospital, Hebi, China.
²³ Department of Critical Care Medicine, Jiaozuo People's Hospital, Jiaozuo, China.
²⁴ Department of Critical Care Medicine, Nanyang Central Hospital, Nanyang, China.

Abstract

Objective: In intensive care units (ICUs), carbapenem-resistant Enterobacterales (CRE) pose a significant threat. We aimed to examine the distribution, epidemiological characteristics, and risk factors for CRE positivity in ICUs.

Materials and methods: This cross-sectional study was conducted in 96 ICUs of 78 hospitals in Henan Province, China. The clinical and microbiological data were collected. A multivariable logistic regression model was used to analyze the risk factors for CRE positivity.

Results: A total of 1,009 patients were enrolled. There was a significant difference in CRE positive rate between pharyngeal and anal swabs (15.16 vs. 19.13%, P < 0.001). A total of 297 carbapenem-resistant Klebsiella pneumoniae (CR-KPN), 22 carbapenem-resistant Escherichia coli (CR-ECO), 6 carbapenem-resistant Enterobacter cloacae (CR-ECL), 19 CR-KPN/CR-ECO, and 2 CR-KPN/CR-ECL were detected. Klebsiella pneumoniae carbapenemase (KPC), New Delhi metallo-beta-lactamase (NDM), and a combination of KPC and NDM were detected in 150, 9, and 11 swab samples, respectively. Multivariable logistic regression analysis determined length of ICU stay, chronic neurological disease, transfer from other hospitals, previous infection, and history of antibiotics exposure as independent risk factors for CRE positivity. Age and cardiovascular diseases were independent risk factors for mixed infections of CRE. The occurrence of CRE in secondary and tertiary hospitals was 15.06 and 25.62%, respectively (P < 0.05). Patients from tertiary hospitals had different clinical features compared with those from secondary hospitals, including longer hospital stays, a higher rate of patients transferred from other hospitals, receiving renal replacement therapy, exposure to immunosuppressive drugs, use of antibiotics, and a higher rate of the previous infection.

Conclusion: In ICUs in Henan Province, CRE positive rate was very high, mostly KPC-type CR-KPN. Patients with prolonged ICU stay, chronic neurological disease, transfer from other hospitals, previous infection, and history of antibiotic exposure are prone to CRE. Age and cardiovascular diseases are susceptibility factors for mixed infections of CRE. The CRE positive rate in tertiary hospitals was higher than that in secondary hospitals, which may be related to the source of patients, antibiotic exposure, disease severity, and previous infection.

Keywords: active screening; bacterial resistance; carbapenem-resistant Enterobacterales (CRE); intensive care unit; prevalence.