Hospitals are primary transmission sites for<unk> -based infections. Up to 75% of hospital admissions attributed to<unk>  were from long-term care facilities or transferred from another hospital. Suboptimal maintenance practices are the largest cause of<unk>  transmission. This includes the failure to adequately clean and disinfect medication cabinets, other surfaces in patient rooms, and portable medical equipment, such as X-ray and ultrasound machines that are used for both<unk>  and non-CRE patients. Thus far,<unk>  have primarily been nosocomial infectious agents. Almost all<unk>  infections occur in people receiving significant medical care in hospitals, long-term acute care facilities, or nursing homes. Independent risk factors for<unk>  infection include use of beta-lactam antibiotics and the use of mechanical ventilation. Patients with diabetes have also been shown to be at an elevated risk for acquiring<unk>  infections. When compared to other hospitalized patients, those admitted from long-term acute care (LTAC) facilities have significantly higher incidence of colonization and infection rates. Another 2012 multicenter study found that over 30% of patients with recent exposure to LTAC were colonized or infected with<unk> . A person susceptible to<unk>  transmission is more likely to be female, have a greater number of parenteral nutrition-days (meaning days by which the person received nutrition via the bloodstream), and to have had a significant number of days breathing through a ventilator. Infections with<unk> -resistant Klebsiella pneumoniae were associated with organ/stem cell transplantation, mechanical ventilation, exposure to antimicrobials, and overall longer length of stay in hospitals. People most likely to acquire<unk> -resistant bacteria are those already receiving medical attention. In a study carried out at Sheba medical center, there was a trend toward worse Charleson Comorbidity scores in patients who acquired CRKP during ICU stay. Those at highest risk are patients receiving an organ or stem cell implantation, use of mechanical ventilation, or have to have an extended stay in the hospital along with exposure to antimicrobials. In a study performed in Singapore, the acquisition of ertapenem-resistant<unk>  to the acquisition of<unk> . Exposure to antibiotics, especially fluoroquinolones, and previous hospitalization dramatically increased the risk of acquisition<unk> -resistant bacteria. This study found that<unk> -resistant acquisition has a significantly higher mortality rate and poorer clinical response compared to that of the ertapenem-resistance acquisition. Bacteruria (also known as urinary tract infection) caused by CRKp and CSKp have similar risk factors. These include prior antibiotic use, admittance to an ICU, use of a permanent urinary catheter, and previous invasive procedures or operations. A retrospective study of patients with CRKp and CSKp infection asserted that the use of cephalosporins (a class of β-lactam antibiotics) used before invasive procedures was higher in patients with CRKp infection, suggesting that it is a risk factor. In a three-year study, the prevalence of<unk>  was shown to be proportional to the lengths of stays of the patients in those hospitals. Policies regarding contact precaution for patients infected or colonized by Gram-negative pathogens were also observed in hospitals reporting decreases in<unk>  prevalence. One case study showed that patients with a compromised immune response are especially susceptible to both<unk>  exposure and infection. In one study, an elderly patient with acute lymphoblastic leukemia being treated in a long-term care facility contracted a<unk>  infection. Her age and condition, combined with her environment and regulation by a catheter and mechanical ventilation, all contributed to a higher susceptibility. This highlights the importance of finding the source of the bacteria, as members of this class of patients are at continued risk for infection. Infection control and prevention of<unk>  should be the main focus in managing patients at high risk. Another major risk factor is being in a country with unregulated antibiotic distribution. In countries where antibiotics are over-the-counter and obtainable without a prescription, the incidence and prevalence of<unk>  infections were higher. One study from Japan found that 6.4% of healthy adults carried ESBL (mostly cefotaximase)-producing strains compared to 58.4% in Thailand, where antibiotics are available over the counter and without prescription. An Egyptian research group found that 63.3% of healthy adults were colonized. In February 2015, the FDA reported about a transmission risk when people undergo a gastroenterology procedure called endoscopic retrograde cholangiopancreatography, where an endoscope enters the mouth, passes the stomach, and ends in the duodenum; if incompletely disinfected, the device can transmit<unk>  from one patient to another. The FDA's safety communication came a day after the UCLA Health System, Los Angeles, notified more than 100 patients that they may have been infected with<unk>  during endoscopies between October 2014 and January 2015. The FDA had issued its first notice about the devices in 2009. Transmission by animals Because the spread of<unk>  bacteria from animals to humans may become a problem in the future, it is advised to monitor<unk>  in livestock, as well as humans.
Carbapenem-resistant enterobacteriaceae
Vancomycin-resistant Enterococcus
Shigatoxigenic and verotoxigenic Escherichia coli
Vancomycin-resistant Staphylococcus aureus
Methicillin-resistant Staphylococcus aureus
Rapid growing mycobacterium
Isolated levocardia
Enteroinvasive Escherichia coli