From the Guidelines
Yes, gender and comorbidities are risk factors for Carbapenem-Resistant Enterobacteriaceae (CRE) carriage, with male gender and certain medical conditions such as diabetes mellitus, chronic kidney disease, and immunosuppressive conditions increasing the risk of CRE colonization.
Risk Factors for CRE Carriage
The risk factors for CRE carriage can be broken down into several key areas, including:
- Gender: Male gender has been associated with higher rates of CRE colonization in many healthcare settings 1.
- Comorbidities: Several medical conditions significantly increase the risk of CRE carriage, including:
- Diabetes mellitus
- Chronic kidney disease
- Solid organ or hematologic malignancies
- Immunosuppressive conditions
- Presence of indwelling medical devices: Such as urinary catheters, central venous catheters, or feeding tubes, which further elevates the risk of CRE colonization 1.
Biological Reasoning
The biological reasoning behind these associations relates to compromised immune function in patients with chronic diseases, increased exposure to healthcare settings and antimicrobials, and physiological changes that may favor colonization by resistant organisms 1.
Infection Control Measures
Healthcare providers should consider these risk factors when implementing infection control measures, particularly for high-risk patients in hospital settings where CRE transmission is more common. Early identification of at-risk patients can guide appropriate infection prevention strategies and antimicrobial stewardship efforts.
Key Considerations
Key considerations for infection control measures include:
- Active screening for CRE using rectal surveillance cultures
- Isolation or cohorting of colonized/infected patients
- Implementation of contact precautions
- Communication among healthcare providers to ensure consistent application of infection control measures 1.
From the Research
Risk Factors for CRE Carriage
The relationship between gender, comorbidities, and the risk of Carbapenem-Resistant Enterobacteriaceae (CRE) carriage is complex and has been investigated in several studies.
- Gender as a Risk Factor: One study found that male gender is associated with an increased risk of CRE infection, with an odds ratio (OR) of 1.9 (95% CI = 1.3-3.4) 2.
- Comorbidities as Risk Factors: Comorbidities such as diabetes mellitus have been identified as independent predictors of subsequent CRE clinical specimens in patients with CRE rectal carriage 3. Other studies have found that patients with CRE infection are more likely to have higher actual body weight compared to colonized patients (P = 0.03) 4.
- Other Risk Factors: Additional risk factors for CRE carriage and infection include:
- Previous exposure to certain antibiotics, such as levofloxacin and trimethoprim/sulfamethoxazole 4
- Travel in Asia and hospitalization in or out of France in the preceding 12 months 2
- Infection in the preceding 3 months 2
- Mechanical ventilation and urine drainage during the current hospitalization 2
- Carriage or infection with another multidrug-resistant organism (MDRO) 5
- Admission to the intensive care unit and receipt of antibiotics 3
CRE Carriage and Infection
The distinction between CRE carriage and infection is important, as patients with CRE infection may have different risk factors and worse clinical outcomes compared to those with CRE colonization 4.
- CRE Infection vs. Colonization: One study found that CRE-infected patients had a longer infection-related hospital stay and were more likely to have previous exposure to certain antibiotics compared to colonized patients 4.
- Risk Factors for CRE Infection: Risk factors for CRE infection include a higher Sequential Organ Failure Assessment (SOFA) score, chronic dialysis, and Klebsiella pneumoniae in the index culture 6.