Factors associated with acquisition of carbapenem-resistant Enterobacteriaceae.
Lilian Silva Lavagnoli, Bil Randerson Bassetti, Thais Dias Lemos Kaiser and 2 others
PMID 29020126WHAT IT FOUND
Hospitalized patients with carbapenem-resistant Enterobacteriaceae had longer stays before testing and more often had surgery.
With only 13 cases, this is a small signal for infection prevention, not proof of cause.
Key findings
01Length of hospitalization prior to sample collection and having a surgical procedure were significantly associated with CRE in univariate analysis.
02Cases had a median 34 days of hospitalization before sample collection, while controls had a median 12 days, and 11 of 13 cases had surgery compared with 19 of 52 controls.
03Nine of 13 CRE isolates tested positive for the bla KPC gene.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study included only 13 cases, so the estimates are unstable and the confidence intervals are wide. The data were collected retrospectively from hospital records, and some information was missing, which could introduce selection or information bias. Controls were randomly selected from the same unit and time period but without a strictly established matching criterion, which can lead to confounding. The study did not know whether control patients had already been colonized by CRE before sample collection. The case definition included CRE isolates with and without the bla KPC gene, so the findings are not specific to one resistance mechanism.
The easy way to misread this
Do not conclude that surgery or longer hospitalization caused CRE infection, or that shortening stays will prevent CRE. This was a small retrospective case-control study with only 13 cases and wide confidence intervals, so it shows association, not causation.