Fecal Carriage of Carbapenem-resistant Enterobacteriaceae in a Chinese University Hospital

Background: Carbapenem-resistant Enterobacteriaceae (CRE) is widespread in China. To date, no study available has specifically determined the prevalence and risk factors of inpatients with CRE intestinal colonization in this region.

Methods: Stool samples were screened for the presence of CRE in a Chinese university hospital. A case-control study was performed to identify risk factors associated with CRE fecal colonization. Case patients were those who had CRE colonization. Control subjects had no microbiologic evidence of CRE colonization. Clinical data were obtained from the medical record.

Results: The prevalence of CRE was 6.6% (20/303 patients), of which 8 had carbapenemase-producing isolates. KPC-2, IMP-4, and NDM-1 were detected from these isolates. Hospital readmissions (odds ratio [OR], 58.067; 95% confidence interval [95% CI]: 5.517-611.134; P = .001), sickbed changes (OR, 45.904; 95% CI: 8.484-248.376; P < .001), invasive procedures (OR, 8.322; 95% CI: 1.996-34.690; P = .004), and vancomycin (OR, 11.552; 95% CI: 1.155-115.574; P = .037) were independently associated with CRE colonization.

Conclusion: This study demonstrated that asymptomatic intestinal carriage of CRE was relatively common in one region of China. Our study suggested that the implementation of effective infection control measures is urgently required to control the transmission of CRE in health care facilities in this country.