Risk Factors for Colonization With Extended-Spectrum Cephalosporin-Resistant and Carbapenem-Resistant Enterobacterales Among Hospitalized Patients in Kenya: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study.

Autor:	Omulo S; Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA.; Washington State University Global Health-Kenya, Nairobi, Kenya.; University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya., Ita T; Washington State University Global Health-Kenya, Nairobi, Kenya., Mugoh R; Washington State University Global Health-Kenya, Nairobi, Kenya., Ayodo C; Washington State University Global Health-Kenya, Nairobi, Kenya., Luvsansharav U; Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA., Bollinger S; Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA., Styczynski A; Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA., Ramay BM; Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA.; Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala., Caudell MA; Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA., Palmer GH; Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA.; Washington State University Global Health-Kenya, Nairobi, Kenya.; University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya., Kariuki S; Kenya Medical Research Institute, Nairobi, Kenya., Call DR; Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA., Smith RM; Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2023 Jul 05; Vol. 77 (Suppl 1), pp. S97-S103.
DOI:	10.1093/cid/ciad258
Abstrakt:	Background: The spread of extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE) represents a significant global public health threat. We identified putative risk factors for ESCrE and CRE colonization among patients in 1 urban and 3 rural hospitals in Kenya. Methods: During a January 2019 and March 2020 cross-sectional study, stool samples were collected from randomized inpatients and tested for ESCrE and CRE. The Vitek2 instrument was used for isolate confirmation and antibiotic susceptibility testing, and least absolute shrinkage and selection operator (LASSO) regression models were used to identify colonization risk factors while varying antibiotic use measures. Results: Most (76%) of the 840 enrolled participants received ≥1 antibiotic in the 14 days preceding their enrollment, primarily ceftriaxone (46%), metronidazole (28%), or benzylpenicillin-gentamycin (23%). For LASSO models that included ceftriaxone administration, ESCrE colonization odds were higher among patients hospitalized for ≥3 days (odds ratio, 2.32 [95% confidence interval, 1.6-3.37]; P < .001), intubated patients (1.73 [1.03-2.91]; P = .009), and persons living with human immunodeficiency virus (1.70 [1.03-2.8]; P = .029). CRE colonization odds were higher among patients receiving ceftriaxone (odds ratio, 2.23 [95% confidence interval, 1.14-4.38]; P = .025) and for every additional day of antibiotic use (1.08 [1.03-1.13]; P = .002). Conclusions: While CRE colonization was strongly associated with ceftriaxone use and duration of antibiotic use, the odds of ESCrE colonization increased with exposure to the hospital setting and invasive medical devices, which may reflect nosocomial transmission. These data suggest several areas where hospitals can intervene to prevent colonization among hospitalized patients, both through robust infection prevention and control practices and antibiotic stewardship programs. Competing Interests: Potential conflicts of interest. D. R. C. received funding for conducting communicable disease research in Kenya from the Centers for Disease Control and Prevention (grant U01GH002143). S. O., T. I., R. M., and C. A. received salaries from the grant. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze:	MEDLINE
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