Outbreak of Carbapenem-resistant Enterobacteriaceae (CRE) in a Long-term Acute Care Facility in the Republic of Korea

Sunwha Jung; Sangshin Park

doi:10.14192/kjicp.2022.27.1.43

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Original Article

Korean J healthc assoc Infect Control Prev 2022; 27(1): 43-50

Published online June 30, 2022 https://doi.org/10.14192/kjicp.2022.27.1.43

Outbreak of Carbapenem-resistant Enterobacteriaceae (CRE) in a Long-term Acute Care Facility in the Republic of Korea

Sunwha Jung^1,2, Sangshin Park^2,3

National Rehabitation Center¹, Graduate School of Urban Public Health, University of Seoul², Department of Urban Big Data Convergence, University of Seoul³, Seoul, Korea

Correspondence to: Sangshin Park
E-mail: spark@uos.ac.kr
ORCID: https://orcid.org/0000-0003-2407-0962

Received: October 5, 2021; Revised: January 25, 2022; Accepted: May 20, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0).

Abstract

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Abstract

Background: Carbapenem-resistant Enterobacteriaceae (CRE) emerged in a long-term acute care hospital in 2017. Therefore, this study aimed to examine the reasons for the occurrence of the CRE epidemic, the risk of infection, its spread, and the effects of interventions.
Methods: A total of 149 patients were hospitalised in a long-term acute care hospital, and 15 of 39 patients in the same ward tested positive. A retrospective cohort study was conducted on all patients (n=39) who were hospitalised in the same ward.
Results: The incidence rates of CRE were 50.0% for the intensive care unit, 2.8% for each general ward, and 10.0% for the entire hospital, with a case fatality rate of 53.3%. The risk factors for its spread included antibiotic use (relative risk [RR]=18.12; 95% confidence interval [CI]=2.64-124.5), ventilator use (RR=3.95; 95% CI=1.53-10.22), decubitus (RR=15.56; 95% CI=2.27-106.8), use of tracheostomy tube (RR=2.75; 95% CI=1.06-7.12), and hemodialysis (RR=2.43; 95% CI=1.21-4.89).
Conclusion: Both the incidence and case fatality rates of CRE were increased when it emerged in a long-term acute care hospital. The risk factors for its spread included antibiotic use, decubitus, tracheostomy, ventilator use, and dialysis. Interventions, including intensive infection monitoring, were effective in preventing the spread and relapse of CRE epidemics.

Keywords: Carbapenem-resistant Enterobacteriaceae (CRE), Long-term acute care hospital, Outbreak