ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2023
Transmission of Carbapenem-Resistant Enterobacterales in an Overcrowded Emergency Department: Controlling the Spread to the Hospital.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 11 citations in OpenAlex.
- Carbapenem-resistant Enterobacterales (CRE) acquisition and molecular characterization following colistin monotherapy and colistin-meropenem combination therapy: findings from the AIDA randomized trial.Antimicrobial resistance and infection control · 2025Trial
- Hidden in the community: poly-clonal spread of KPC- or NDM-producing Klebsiella pneumoniae revealed by whole-genome sequencing in Southeastern Brazil.International microbiology : the official journal of the Spanish Society for Microbiology · 2026Article
- National Survey on Infection Prevention and Control in United States Emergency Departments.The western journal of emergency medicine · 2025Article
- Socioeconomic position and urban environments as drivers of antimicrobial resistance? An ecological study in Germany, 2010 to 2019.Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin · 2025Article
- Bloodstream infection by Lactobacillus rhamnosus in a haematology patient: why metagenomics can make the difference.Gut pathogens · 2025Article
- The potential of the microbiome as a target for prevention and treatment of carbapenem-resistant Enterobacteriaceae infections.Frontiers in cellular and infection microbiology · 2025Review
- Investigating Resistance to Carbapenems in Enterobacterales: A Descriptive Epidemiological Study of 2021 Screening in an Italian Teaching Hospital.Pathogens (Basel, Switzerland) · 2023Article
- Antibiotic Resistance: A Global Problem and the Need to Do More.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- Prevalence of intestinal colonization and nosocomial infection with carbapenem-resistantFrontiers in public health · 2023Article
Corrections and comments
- Erratum issued
Authors and funding
10 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundOvercrowded emergency departments (EDs) may increase the risk of carbapenem-resistant Enterobacterales (CRE) transmission.
methodsWe conducted a quasi-experimental study divided into 2 phases (baseline and intervention) to investigate the impact of an intervention on the acquisition rate and identify risk factors for CRE colonization in an ED of a tertiary academic hospital in Brazil. In both phases, we did universal screening with rapid molecular test (blaKPC, blaNDM, blaOXA48, blaOXA23, and blaIMP) and culture. At baseline, both screening test results were not reported, and patients were put under contact precautions (CP) based on previous colonization or infection by multidrug-resistant organisms. During the intervention, all patients hospitalized in the ED were placed in empiric CP and the result of CRE screening was reported; if negative, patients were released from CP. Patients were rescreened if they stayed >7 days in the ED or were transferred to an intensive care unit.
resultsA total of 845 patients were included: 342 in baseline and 503 in intervention. Colonization at admission was 3.4% by culture and molecular test. Acquisition rates during ED stay dropped from 4.6% (11/241) to 1% (5/416) during intervention (P = .06). The aggregated antimicrobial use in the ED decreased from phase 1 to phase 2 (804 defined daily doses [DDD]/1000 patients to 394 DDD/1000 patients, respectively). Length of stay >2 days in the ED was a risk factor for CRE acquisition (adjusted odds ratio, 4.58 [95% confidence interval, 1.44-14.58]; P = .01).
conclusionsEarly empiric CP and rapid identification of CRE-colonized patients reduce cross-transmission in ED. Nevertheless, staying >2 days in ED compromised efforts.
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