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SDG 3: Antimicrobial resistance

Abstract

Background

Post-acute care hospitals (PACH) may act as regional reservoirs for multidrug-resistant organisms.

Aim

We aimed to investigate the prevalence of carbapenem-resistant (CRAB) carriers and identify risk factors for CRAB carriage in PACH.

Methods

We conducted a point prevalence survey in 18 PACH in Israel from June to December 2021. We screened patients in 55 wards of four types (mechanical ventilation, skilled nursing, sub-acute and rehabilitation) for CRAB carriage from skin, rectum and tracheostomy secretions (if applicable). We collected data on patient characteristics (including prior CRAB carriage) and ward and institution characteristics. We calculated the prevalence of CRAB carriers, the percentage of newly detected carriers, and assessed predictors of CRAB carriage using a mixed-effects logistic regression model.

Results

We screened 1,725 patients, with 385 (22%) testing positive for CRAB. The median prevalence of CRAB carriers was 48% (interquartile range (IQR): 33–70) in ventilation wards, 28% (IQR: 18–46) in skilled nursing wards, 8% (IQR: 6–13) in sub-acute wards and 0% (IQR: 0–3) in rehabilitation wards. Only 31% (118/385) had a known history of CRAB carriage. Individual risk factors for CRAB positivity included known CRAB carriage, bedsores and presence of a feeding tube. Modifiable ward-level risk factors included poor availability of alcohol-based hand rub (adjusted odds ratio (aOR) = 3.22; 95% confidence interval (CI): 1.52–6.81) and suctioning in common areas (aOR = 2.23; 95% CI: 1.30–3.85).

Conclusions

The hidden reservoir of CRAB carriers in Israeli ventilation and skilled nursing wards is large. We identified modifiable risk factors at ward level, highlighting areas for targeted intervention.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
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2025-04-17
2025-04-19
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Prevalence and risk factors for carriage of carbapenem-resistant Acinetobacter baumannii in post-acute care hospitals, Israel, 2021
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Vered+Schechner&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Schechner Vered</a>, <a href="/search?value1=Samira+Masarwa&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Masarwa Samira</a>, <a href="/search?value1=Gabrielle+D+Levi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Levi Gabrielle D</a>, <a href="/search?value1=Adi+Cohen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Cohen Adi</a>, <a href="/search?value1=Fadi+Assi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Assi Fadi</a>, <a href="/search?value1=Moshe+Bechor&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bechor Moshe</a>, <a href="/search?value1=Elizabeth+Temkin&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Temkin Elizabeth</a>, <a href="/search?value1=Alona+Keren-Paz&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Keren-Paz Alona</a>, <a href="/search?value1=Mitchell+J+Schwaber&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Schwaber Mitchell J</a>, <a href="/search?value1=Yehuda+Carmeli&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Carmeli Yehuda</a>, <a href="/search?value1=the+Israel+PACH+CRAB+Working+Group&option1=author&noRedirect=true" class="nonDisambigAuthorLink">the Israel PACH CRAB Working Group</a></span>. Prevalence and risk factors for carriage of carbapenem-resistant Acinetobacter baumannii in post-acute care hospitals, Israel, 2021. <a href="/content/ecdc">Euro Surveill.</a> 2025;30(15):pii=2400563. <a href="https://doi.org/10.2807/1560-7917.ES.2025.30.15.2400563" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2025.30.15.2400563</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 25 Aug 2024;&nbsp;&nbsp; <span class="generated">Accepted</span>: 13 Dec 2024 </span> </p>
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