Prevalence of, and risk factors for, carriage of carbapenem-resistant Enterobacteriaceae among hospitalized patients in Japan

N. Yamamoto, R. Asada, R. Kawahara, H. Hagiya, Y. Akeda, R. K. Shanmugakani, H. Yoshida, S. Yukawa, K. Yamamoto, Y. Takayama, H. Ohnishi, T. Taniguchi, T. Matsuoka, K. Matsunami, I. Nishi, T. Kase, S. Hamada, K. Tomono

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background The prevalence of carbapenem-resistant Enterobacteriaceae (CRE) has been reported to be lower in Japan than in many other countries. However, extensive surveillance for CRE carriage has not been performed in Japan. Aim To investigate the prevalence of CRE carriage in Japan among convalescent patients considered to be at high risk of being CRE carriers using an improved selective culture medium. Methods A cross-sectional survey was conducted in 22 acute care hospitals (ACHs) and 21 long-term care hospitals (LTCHs) in northern Osaka from December 2015 to January 2016. Patients who used incontinence aids, an enteral feeding tube or a urinary catheter were enrolled. Faecal specimens were examined using the newly developed M-ECC for imipenemase (IMP)-producing CRE, which is the most prevalent form of CRE in Japan. The positive isolates were analysed by polymerase chain reaction and sequencing. Risk factors associated with carriage were analysed by logistic regression. Findings Among 1507 patients, 184 (12.2%) carried CRE. The percentage of positive patients was significantly higher in LTCHs (14.9%) than in ACHs (3.6%) (P<0.001). Risk factors for CRE carriage were longer hospital stay [odds ratio (OR) 2.59; 95% confidence interval (CI) 1.87–3.60], enteral feeding (OR 3.03, 95% CI 2.08–4.42) and antibiotic exposure (OR 2.00, 95% CI 1.40–2.87). Among the 233 CRE isolates identified, 223 were IMP producers; the remaining isolates did not produce carbapenemase. Conclusions This is the first Japanese report to demonstrate the significant spread of CRE in both ACHs and LTCHs using an improved selective medium. A coordinated regional approach may help to prevent further spread.

Original languageEnglish
Pages (from-to)212-217
Number of pages6
JournalJournal of Hospital Infection
Volume97
Issue number3
DOIs
Publication statusPublished - Nov 2017
Externally publishedYes

Fingerprint

Carbapenems
Enterobacteriaceae
Japan
Long-Term Care
Odds Ratio
Enteral Nutrition
Confidence Intervals
Urinary Catheters
Culture Media
Length of Stay
Cross-Sectional Studies
Logistic Models
Anti-Bacterial Agents
Polymerase Chain Reaction

Keywords

  • Asymptomatic carriers
  • Carbapenem-resistant Enterobacteriaceae (CRE)
  • Surveillance

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Prevalence of, and risk factors for, carriage of carbapenem-resistant Enterobacteriaceae among hospitalized patients in Japan. / Yamamoto, N.; Asada, R.; Kawahara, R.; Hagiya, H.; Akeda, Y.; Shanmugakani, R. K.; Yoshida, H.; Yukawa, S.; Yamamoto, K.; Takayama, Y.; Ohnishi, H.; Taniguchi, T.; Matsuoka, T.; Matsunami, K.; Nishi, I.; Kase, T.; Hamada, S.; Tomono, K.

In: Journal of Hospital Infection, Vol. 97, No. 3, 11.2017, p. 212-217.

Research output: Contribution to journalArticle

Yamamoto, N, Asada, R, Kawahara, R, Hagiya, H, Akeda, Y, Shanmugakani, RK, Yoshida, H, Yukawa, S, Yamamoto, K, Takayama, Y, Ohnishi, H, Taniguchi, T, Matsuoka, T, Matsunami, K, Nishi, I, Kase, T, Hamada, S & Tomono, K 2017, 'Prevalence of, and risk factors for, carriage of carbapenem-resistant Enterobacteriaceae among hospitalized patients in Japan', Journal of Hospital Infection, vol. 97, no. 3, pp. 212-217. https://doi.org/10.1016/j.jhin.2017.07.015
Yamamoto, N. ; Asada, R. ; Kawahara, R. ; Hagiya, H. ; Akeda, Y. ; Shanmugakani, R. K. ; Yoshida, H. ; Yukawa, S. ; Yamamoto, K. ; Takayama, Y. ; Ohnishi, H. ; Taniguchi, T. ; Matsuoka, T. ; Matsunami, K. ; Nishi, I. ; Kase, T. ; Hamada, S. ; Tomono, K. / Prevalence of, and risk factors for, carriage of carbapenem-resistant Enterobacteriaceae among hospitalized patients in Japan. In: Journal of Hospital Infection. 2017 ; Vol. 97, No. 3. pp. 212-217.
@article{5388f44e79144e19b2e14c53db30e13f,
title = "Prevalence of, and risk factors for, carriage of carbapenem-resistant Enterobacteriaceae among hospitalized patients in Japan",
abstract = "Background The prevalence of carbapenem-resistant Enterobacteriaceae (CRE) has been reported to be lower in Japan than in many other countries. However, extensive surveillance for CRE carriage has not been performed in Japan. Aim To investigate the prevalence of CRE carriage in Japan among convalescent patients considered to be at high risk of being CRE carriers using an improved selective culture medium. Methods A cross-sectional survey was conducted in 22 acute care hospitals (ACHs) and 21 long-term care hospitals (LTCHs) in northern Osaka from December 2015 to January 2016. Patients who used incontinence aids, an enteral feeding tube or a urinary catheter were enrolled. Faecal specimens were examined using the newly developed M-ECC for imipenemase (IMP)-producing CRE, which is the most prevalent form of CRE in Japan. The positive isolates were analysed by polymerase chain reaction and sequencing. Risk factors associated with carriage were analysed by logistic regression. Findings Among 1507 patients, 184 (12.2{\%}) carried CRE. The percentage of positive patients was significantly higher in LTCHs (14.9{\%}) than in ACHs (3.6{\%}) (P<0.001). Risk factors for CRE carriage were longer hospital stay [odds ratio (OR) 2.59; 95{\%} confidence interval (CI) 1.87–3.60], enteral feeding (OR 3.03, 95{\%} CI 2.08–4.42) and antibiotic exposure (OR 2.00, 95{\%} CI 1.40–2.87). Among the 233 CRE isolates identified, 223 were IMP producers; the remaining isolates did not produce carbapenemase. Conclusions This is the first Japanese report to demonstrate the significant spread of CRE in both ACHs and LTCHs using an improved selective medium. A coordinated regional approach may help to prevent further spread.",
keywords = "Asymptomatic carriers, Carbapenem-resistant Enterobacteriaceae (CRE), Surveillance",
author = "N. Yamamoto and R. Asada and R. Kawahara and H. Hagiya and Y. Akeda and Shanmugakani, {R. K.} and H. Yoshida and S. Yukawa and K. Yamamoto and Y. Takayama and H. Ohnishi and T. Taniguchi and T. Matsuoka and K. Matsunami and I. Nishi and T. Kase and S. Hamada and K. Tomono",
year = "2017",
month = "11",
doi = "10.1016/j.jhin.2017.07.015",
language = "English",
volume = "97",
pages = "212--217",
journal = "Journal of Hospital Infection",
issn = "0195-6701",
publisher = "W.B. Saunders Ltd",
number = "3",

}

TY - JOUR

T1 - Prevalence of, and risk factors for, carriage of carbapenem-resistant Enterobacteriaceae among hospitalized patients in Japan

AU - Yamamoto, N.

AU - Asada, R.

AU - Kawahara, R.

AU - Hagiya, H.

AU - Akeda, Y.

AU - Shanmugakani, R. K.

AU - Yoshida, H.

AU - Yukawa, S.

AU - Yamamoto, K.

AU - Takayama, Y.

AU - Ohnishi, H.

AU - Taniguchi, T.

AU - Matsuoka, T.

AU - Matsunami, K.

AU - Nishi, I.

AU - Kase, T.

AU - Hamada, S.

AU - Tomono, K.

PY - 2017/11

Y1 - 2017/11

N2 - Background The prevalence of carbapenem-resistant Enterobacteriaceae (CRE) has been reported to be lower in Japan than in many other countries. However, extensive surveillance for CRE carriage has not been performed in Japan. Aim To investigate the prevalence of CRE carriage in Japan among convalescent patients considered to be at high risk of being CRE carriers using an improved selective culture medium. Methods A cross-sectional survey was conducted in 22 acute care hospitals (ACHs) and 21 long-term care hospitals (LTCHs) in northern Osaka from December 2015 to January 2016. Patients who used incontinence aids, an enteral feeding tube or a urinary catheter were enrolled. Faecal specimens were examined using the newly developed M-ECC for imipenemase (IMP)-producing CRE, which is the most prevalent form of CRE in Japan. The positive isolates were analysed by polymerase chain reaction and sequencing. Risk factors associated with carriage were analysed by logistic regression. Findings Among 1507 patients, 184 (12.2%) carried CRE. The percentage of positive patients was significantly higher in LTCHs (14.9%) than in ACHs (3.6%) (P<0.001). Risk factors for CRE carriage were longer hospital stay [odds ratio (OR) 2.59; 95% confidence interval (CI) 1.87–3.60], enteral feeding (OR 3.03, 95% CI 2.08–4.42) and antibiotic exposure (OR 2.00, 95% CI 1.40–2.87). Among the 233 CRE isolates identified, 223 were IMP producers; the remaining isolates did not produce carbapenemase. Conclusions This is the first Japanese report to demonstrate the significant spread of CRE in both ACHs and LTCHs using an improved selective medium. A coordinated regional approach may help to prevent further spread.

AB - Background The prevalence of carbapenem-resistant Enterobacteriaceae (CRE) has been reported to be lower in Japan than in many other countries. However, extensive surveillance for CRE carriage has not been performed in Japan. Aim To investigate the prevalence of CRE carriage in Japan among convalescent patients considered to be at high risk of being CRE carriers using an improved selective culture medium. Methods A cross-sectional survey was conducted in 22 acute care hospitals (ACHs) and 21 long-term care hospitals (LTCHs) in northern Osaka from December 2015 to January 2016. Patients who used incontinence aids, an enteral feeding tube or a urinary catheter were enrolled. Faecal specimens were examined using the newly developed M-ECC for imipenemase (IMP)-producing CRE, which is the most prevalent form of CRE in Japan. The positive isolates were analysed by polymerase chain reaction and sequencing. Risk factors associated with carriage were analysed by logistic regression. Findings Among 1507 patients, 184 (12.2%) carried CRE. The percentage of positive patients was significantly higher in LTCHs (14.9%) than in ACHs (3.6%) (P<0.001). Risk factors for CRE carriage were longer hospital stay [odds ratio (OR) 2.59; 95% confidence interval (CI) 1.87–3.60], enteral feeding (OR 3.03, 95% CI 2.08–4.42) and antibiotic exposure (OR 2.00, 95% CI 1.40–2.87). Among the 233 CRE isolates identified, 223 were IMP producers; the remaining isolates did not produce carbapenemase. Conclusions This is the first Japanese report to demonstrate the significant spread of CRE in both ACHs and LTCHs using an improved selective medium. A coordinated regional approach may help to prevent further spread.

KW - Asymptomatic carriers

KW - Carbapenem-resistant Enterobacteriaceae (CRE)

KW - Surveillance

UR - http://www.scopus.com/inward/record.url?scp=85028755242&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85028755242&partnerID=8YFLogxK

U2 - 10.1016/j.jhin.2017.07.015

DO - 10.1016/j.jhin.2017.07.015

M3 - Article

C2 - 28736270

AN - SCOPUS:85028755242

VL - 97

SP - 212

EP - 217

JO - Journal of Hospital Infection

JF - Journal of Hospital Infection

SN - 0195-6701

IS - 3

ER -