Chen Wen Kai, Yang Yong, Tan Ban Hock
Department of Epidemiology, Singapore General Hospital, Singapore.
Department of Infectious Diseases, Singapore General Hospital, Singapore.
Open Forum Infect Dis. 2019 Feb 1;6(2):ofz006. doi: 10.1093/ofid/ofz006. eCollection 2019 Feb.
Carbapenemase production by carbapenemase-producing carbapenem-resistant (CP-CRE) is encoded by a variety of genes on mobile genetic elements. Patients colonized by 1 genotype of CP-CRE may be subsequently infected by another genotype of CP-CRE. We sought to determine whether CP-CRE carriers who developed infection with another genotype had a higher mortality risk.
A retrospective cohort study was conducted using collected data from January 2012 to December 2016. Clinical isolates of CP-CRE were analyzed among the CP-CRE carriers who had developed an infection during their stay in the hospital. Comparison was made between CP-CRE carriers who developed clinical isolates of another genotype and those whose clinical isolates were of the same CP-CRE genotype that they were originally colonized with. The primary outcome analyzed was the 14-day mortality rate.
A total of 73 CP-CRE carriers who had developed infection were analyzed. Ten (15.4%) of the carriers who developed an infection with clinical isolates of the same CP-CRE genotype died within 14 days, whereas 5 (62.5%) of those who developed an infection with clinical isolates of a different genotype died. This represented a 6-fold increase (adjusted relative risk, 6.36; 95% confidence interval, 1.75-23.06; = .005) in the 14-day mortality rate.
CP-CRE carriers who developed clinical isolates of another genotype are at risk of increased mortality. This is a novel finding that is of interest to health care organizations worldwide, with profound implications for infection control measures, such as patient and staff cohorting.
产碳青霉烯酶的耐碳青霉烯肠杆菌科细菌（CP-CRE）产生的碳青霉烯酶由移动遗传元件上的多种基因编码。被一种基因型的CP-CRE定植的患者随后可能会被另一种基因型的CP-CRE感染。我们试图确定感染另一种基因型的CP-CRE携带者是否有更高的死亡风险。
利用2012年1月至2016年12月收集的数据进行回顾性队列研究。对住院期间发生感染的CP-CRE携带者的临床分离株进行分析。比较出现另一种基因型临床分离株的CP-CRE携带者和临床分离株与最初定植的CP-CRE基因型相同的携带者。分析的主要结局是14天死亡率。
共分析了73例发生感染的CP-CRE携带者。感染相同CP-CRE基因型临床分离株的携带者中有10例（15.4%）在14天内死亡，而感染不同基因型临床分离株的携带者中有5例（62.5%）死亡。这表明14天死亡率增加了6倍（调整后的相对风险为6.36；95%置信区间为1.75 - 23.06；P = 0.005）。
出现另一种基因型临床分离株的CP-CRE携带者有死亡风险增加的情况。这是一项新发现，引起了全球医疗机构的关注，对感染控制措施（如患者和工作人员分组）具有深远影响。
