Schechner et al identified a number of factors that can help to identify a patient who continues to be a rectal carrier of carbapenem-resistant Enterobacteriaceae (CRE). A carrier of CRE is a high risk patient who requires special handling to avoid transmission ot other patients. The authors are from Tel Aviv Sourasky Medical Center.

Patient selection: A patient with a positive rectal screen for carbapenem-resistant Enterobacteria at the last previous hospital encounter.


Predictors of continued carriage of resistant organisms:

(1) history of prior fluoroquinolone therapy

(2) admission from another hospital or other institution

(3) time interval <= 3 months since the first isolate of a CRE from the patient


If none of these factors are present, then the chances that a screen for CRE will be positive at a hospital admission is 14%. If one or more factors is present then the risk is 50%.


If a patient who is at high risk for CRE needs to be admitted to a hospital:

(1) The patient should be placed in contact isolation.

(2) There should be heightened environmental cleaning.

(3) There should be increased emphasis on hand hygiene in caregivers.

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