Title: Predictors for the Acquisition of Carbapenem Resistance Enterobacteriaceae (CRE) from a Teaching Hospital of Northeastern Nigeria
Authors: Yahaya Mohammed, Sambo B. Zailani, Anthony O. Onipede, Galadima B. Gadzama, Baffa Sule Ibrahim
DOI: https://dx.doi.org/10.18535/jmscr/v5i3.64
Abstract
Background: Carbapenem resistance Enterobacteriaceae (CRE) has emerged as global pathogen capable of widespread transmission and complicating treatment options for patients. CRE have been reported globally. However, there is dearth of study on knowledge for predictors of CRE in patients from our setting. We set out to determine predictors of infection among patients infected with CRE.
Methodology: We isolated species of Enterobacteriaceae from patients that were admitted in various units of University of Maiduguri Teaching Hospital (UMTH) Maiduguri. We obtain data on socio-demographic characteristics, co-morbidities and some associated factors. We determined their CRE status and then classified them as CRE positiveor CRE negative based on the possession the resistance genes. We conducted univariate, bivariate and multivariate analyses to compute proportions and odd ratios with 95% CI using SPSS version 20.
Results: The factors significantly associated with the acquisition of carbapenem resistance Enterobacteriaceae (CRE) based on chi-square test were; level of education (X2 = 15.570, P-value = 0.004) of the patients, ward of admission (X2 = 21.765, P-value = 0.000), number of days on admission (X2 = 11.218, P-value = 0.004), use of medical device (X2= 26.893, P-value = 0.000) and prior antibiotic usage (X2 = 35.729, P-value = 0.000).
Predictors of CRE using multivariate analysis were; secondary school level of education (OR = 8.330, 95% CI = 3.000-50.401), admission in intensive care unit (OR = 11.135, 95% CI = 8.000-19.110), admission days greater than 20 days (OR = 2.580, 95% CI = 1.011-15.101), use of urethral catheter (OR = 3.518, 95% CI = 2.00-9.821) and prior administration of third generation cephalosporin’s (OR = 15.303, 95% CI = 7.034-19.107).
Conclusion: Our study shows that patients admitted in ICU, those with indwelling urinary catheter and those placed on third generation cephalosporin’s are at higher risk of CRE acquisition. Consequently, we recommend that patient and caregiver education, antibiotic stewardship programs, enforcement of infection control practices and continuous surveillance should be given priority.
Keywords: Carbapenem, Resistance, Risk factors, Antibiotic.
