Risk Factor Analysis for Extended-Spectrum Beta-Lactamase Producing Enterobacterales Colonization or Infection: Evaluation of a Novel Approach to Assess Local Prevalence as a Risk Factor

Details

• Alternative Title:
  Infect Control Hosp Epidemiol
• Personal Author:
  Cherian, Jerald ; Cosgrove, Sara E. ; Haghpanah, Fardad ; Klein, Eili Y.
• Corporate Authors:
  Centers for Disease Control and Prevention’s Prevention Epicenters Program ; Modeling Infectious Diseases in Healthcare Network
• Description:
  Objective:
  
  To explore an approach to identify the risk of local prevalence of extended-spectrum beta-lactamase producing Enterobacterales (ESBL-E) on ESBL-E colonization or infection, and reassess known risk factors.
  
  Design:
  
  Case-control study.
  
  Setting:
  
  Johns Hopkins Health System emergency departments (EDs) in the Baltimore-Washington, D.C. region.
  
  Patients:
  
  Patients aged ≥18 years with a culture growing Enterobacterales between 4/2019–12/2021. Cases had a culture growing an ESBL-E.
  
  Methods:
  
  Addresses were linked to Census Block Groups and placed into communities using a clustering algorithm. Prevalence in each community was estimated by the proportion of ESBL-E among Enterobacterales isolates. Logistic regression was used to determine risk factors for ESBL-E colonization or infection.
  
  Results:
  
  ESBL-E were detected in 1167 of 11,229 patients (10.4%). Risk factors included a history of ESBL-E in the prior year (OR, 15.62; 95% CI, 11.25–21.68), and exposure to a skilled nursing or long term care facility (OR, 1.66; 95% CI, 1.39–1.99), 3rd generation cephalosporin (OR, 1.83; 95% CI, 1.50–2.23), carbapenem (OR, 2.01; 95% CI, 1.46–2.78) or trimethoprim-sulfamethoxazole (OR, 1.53; 95% CI, 1.05–2.22) within the prior 6 months. Patients were at lower risk if their community had a prevalence <25th percentile in the prior 3 months (OR, 0.84; 95% CI, 0.71–0.98), 6 months (OR, 0.84; 95% CI, 0.71–0.99) or 12 months (OR, 0.81; 95% CI, 0.69–0.96). There was no association between being in a community >75th percentile and the outcome.
  
  Conclusions:
  
  This method of defining the recent local prevalence of ESBL-E may partially capture differences in the likelihood of a patient having an ESBL-E.
  
  
• Source:
  Infect Control Hosp Epidemiol. :1-8
• Pubmed ID:
  37114753
• Pubmed Central ID:
  PMC11005063
• Document Type:
  Journal Article
• Funding:
  T32 AI007291/AI/NIAID NIH HHSUnited States/ ; U01 CK000589/CK/NCEZID CDC HHSUnited States/ ; U01CK000589/ACL/ACL HHSUnited States/ ; U54 CK000617/CK/NCEZID CDC HHSUnited States/
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:94ee68577ee32984dfe93606b09ee274dba92bd73b285a6309c18fede5d9b261fe1efed231ccaca704121baf38677c10e5027f9f9fecb534d31436dc76ff5372
• Download URL:
  https://stacks.cdc.gov/view/cdc/154699/cdc_154699_DS1.pdf
• File Type:
  [PDF - 362.55 KB ]