From the Guidelines
Comorbidities significantly increase the odds for Carbapenem-Resistant Enterobacteriaceae (CRE) carriage, as they compromise the body's natural defense mechanisms and often necessitate healthcare interventions that serve as exposure opportunities. Patients with multiple underlying health conditions, such as diabetes, chronic kidney disease, immunosuppression, and severe lung disease, are more vulnerable to CRE colonization and subsequent infection 1. This increased risk is attributed to the fact that comorbidities frequently require more frequent and prolonged hospitalizations, increased antibiotic exposure, and more invasive procedures like mechanical ventilation, central venous catheters, or urinary catheters—all established risk factors for CRE acquisition 1.
Key Factors Contributing to Increased Risk
- Frequent and prolonged hospitalizations
- Increased antibiotic exposure
- Invasive procedures such as mechanical ventilation, central venous catheters, or urinary catheters
- Compromised immune function due to conditions like diabetes
- Impaired wound healing, creating favorable conditions for resistant organisms to colonize
Importance in Healthcare Settings
The relationship between comorbidities and CRE carriage is particularly important in healthcare settings, where identifying high-risk patients can guide targeted screening and implementation of enhanced infection control measures to prevent transmission to other vulnerable patients 1. By recognizing the role of comorbidities in increasing the risk of CRE carriage, healthcare providers can take proactive steps to mitigate this risk and protect patient safety.
Clinical Implications
Given the strong association between comorbidities and CRE carriage, it is essential for healthcare providers to consider a patient's comorbidity profile when assessing their risk for CRE colonization and subsequent infection 1. This consideration can inform decisions regarding the need for enhanced infection control measures, targeted screening, and potentially, decolonization strategies to reduce the risk of CRE transmission in healthcare settings.
From the Research
Comorbidities and CRE Carriage
- Comorbidities, or the presence of one or more additional diseases or disorders, can increase the risk of various infections, including those caused by Carbapenem-Resistant Enterobacteriaceae (CRE) 2.
- However, the provided studies do not directly address the relationship between comorbidities and the risk of CRE carriage.
- The studies focus on the treatment options for CRE infections, the epidemiology of CRE, and the mechanisms of resistance 3, 4, 5, 6.
Risk Factors for CRE Carriage
- The presence of underlying medical conditions, such as those requiring immunosuppressive therapy or chemotherapy, can increase the risk of CRE infections 5.
- Exposure to CRE in healthcare settings, livestock, or the environment can also contribute to the risk of CRE carriage 6.
- However, the specific relationship between comorbidities and CRE carriage is not explicitly addressed in the provided studies.
Treatment Options for CRE Infections
- Several treatment options are available for CRE infections, including ceftazidime-avibactam, meropenem-vaborbactam, and imipenem-relebactam 3, 4, 2.
- The choice of treatment depends on various factors, including the patient's susceptibility profile, the type and degree of infection, and personal characteristics 2.
- The provided studies highlight the importance of tailored treatment approaches and the need for ongoing research into new treatment options for CRE infections.