Risk factors for colonization with extended-spectrum cephalosporin-resistant and carbapenem-resistant Enterobacterales among hospitalized patients in Guatemala: An Antibiotic Resistance in Communities and Hospitals (ARCH) study.

Autor:	Caudell MA; Washington State University, Paul G. Allen School for Global Health, Pullman, USA., Castillo C; Universidad del Valle de Guatemala, Center for Health Studies, Guatemala City, Guatemala., Santos LF; Universidad del Valle de Guatemala, Center for Health Studies, Guatemala City, Guatemala., Grajeda L; Universidad del Valle de Guatemala, Center for Health Studies, Guatemala City, Guatemala., Romero JC; Universidad del Valle de Guatemala, Center for Health Studies, Guatemala City, Guatemala., Lopez MR; Universidad del Valle de Guatemala, Center for Health Studies, Guatemala City, Guatemala., Omulo S; Universidad del Valle de Guatemala, Center for Health Studies, Guatemala City, Guatemala.; Washington State University, Global Health-Kenya, Nairobi, Kenya., Ning MF; U.S. Centers for Disease Control and Prevention, Guatemala City, Central America Regional Office, Guatemala., Palmer GH; Washington State University, Paul G. Allen School for Global Health, Pullman, USA., Call DR; Washington State University, Paul G. Allen School for Global Health, Pullman, USA., Cordon-Rosales C; Washington State University, Paul G. Allen School for Global Health, Pullman, USA.; Universidad del Valle de Guatemala, Center for Health Studies, Guatemala City, Guatemala., Smith RM; U.S. Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion, Atlanta, USA., Herzig CTA; U.S. Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion, Atlanta, USA., Styczynski A; U.S. Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion, Atlanta, USA., Ramay BM; Washington State University, Paul G. Allen School for Global Health, Pullman, USA.; Universidad del Valle de Guatemala, Center for Health Studies, Guatemala City, Guatemala.
Jazyk:	angličtina
Zdroj:	IJID regions [IJID Reg] 2024 Mar 30; Vol. 11, pp. 100361. Date of Electronic Publication: 2024 Mar 30 (Print Publication: 2024).
DOI:	10.1016/j.ijregi.2024.100361
Abstrakt:	Objectives: The spread of extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE) has resulted in increased morbidity, mortality, and health care costs worldwide. To identify the factors associated with ESCrE and CRE colonization within hospitals, we enrolled hospitalized patients at a regional hospital located in Guatemala. Methods: Stool samples were collected from randomly selected patients using a cross-sectional study design (March-September, 2021), and samples were tested for the presence of ESCrE and CRE. Hospital-based and household variables were examined for associations with ESCrE and CRE colonization using lasso regression models, clustered by ward (n = 21). Results: A total of 641 patients were enrolled, of whom complete data sets were available for 593. Colonization with ESCrE (72.3%, n = 429/593) was negatively associated with carbapenem administration (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.11-0.42) and positively associated with ceftriaxone administration (OR 1.61, 95% CI 1.02-2.53), as was reported hospital admission within 30 days of the current hospitalization (OR 2.84, 95% CI 1.19-6.80). Colonization with CRE (34.6%, n = 205 of 593) was associated with carbapenem administration (OR 2.62, 95% CI 1.39-4.97), reported previous hospital admission within 30 days of current hospitalization (OR 2.58, 95% CI 1.17-5.72), hospitalization in wards with more patients (OR 1.05, 95% CI 1.02-1.08), hospitalization for ≥4 days (OR 3.07, 95% CI 1.72-5.46), and intubation (OR 2.51, 95% CI 1.13-5.59). No household-based variables were associated with ESCrE or CRE colonization in hospitalized patients. Conclusion: The hospital-based risk factors identified in this study are similar to what has been reported for risk of health care-associated infections, consistent with colonization being driven by hospital settings rather than community factors. This also suggests that colonization with ESCrE and CRE could be a useful metric to evaluate the efficacy of infection and prevention control programs in clinics and hospitals. Competing Interests: The authors have no competing interests to declare. (© 2024 The Author(s).)
Databáze:	MEDLINE
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