Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA.
Division of Infectious Diseases and Center for Antimicrobial Resistance and Microbial Genomics, UTHealth, Houston, TX, USA; Center for Infectious Diseases, UTHealth, Houston, TX, USA; Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia.
Lancet Infect Dis. 2020 Jun;20(6):731-741. doi: 10.1016/S1473-3099(19)30755-8. Epub 2020 Mar 6.
Carbapenem-resistant Enterobacterales (CRE) are a global threat. We aimed to describe the clinical and molecular characteristics of Centers for Disease Control and Prevention (CDC)-defined CRE in the USA.
CRACKLE-2 is a prospective, multicentre, cohort study. Patients hospitalised in 49 US hospitals, with clinical cultures positive for CDC-defined CRE between April 30, 2016, and Aug 31, 2017, were included. There was no age exclusion. The primary outcome was desirability of outcome ranking (DOOR) at 30 days after index culture. Clinical data and bacteria were collected, and whole genome sequencing was done. This trial is registered with ClinicalTrials.gov, number NCT03646227.
1040 patients with unique isolates were included, 449 (43%) with infection and 591 (57%) with colonisation. The CDC-defined CRE admission rate was 57 per 100 000 admissions (95% CI 45-71). Three subsets of CDC-defined CRE were identified: carbapenemase-producing Enterobacterales (618 [59%] of 1040), non-carbapenemase-producing Enterobacterales (194 [19%]), and unconfirmed CRE (228 [22%]; initially reported as CRE, but susceptible to carbapenems in two central laboratories). Klebsiella pneumoniae carbapenemase-producing clonal group 258 K pneumoniae was the most common carbapenemase-producing Enterobacterales. In 449 patients with CDC-defined CRE infections, DOOR outcomes were not significantly different in patients with carbapenemase-producing Enterobacterales, non-carbapenemase-producing Enterobacterales, and unconfirmed CRE. At 30 days 107 (24%, 95% CI 20-28) of these patients had died.
Among patients with CDC-defined CRE, similar outcomes were observed among three subgroups, including the novel unconfirmed CRE group. CDC-defined CRE represent diverse bacteria, whose spread might not respond to interventions directed to carbapenemase-producing Enterobacterales.
National Institutes of Health.
耐碳青霉烯肠杆菌科（CRE）是一种全球性威胁。我们旨在描述美国疾病控制与预防中心（CDC）定义的 CRE 的临床和分子特征。
CRACKLE-2 是一项前瞻性、多中心、队列研究。2016 年 4 月 30 日至 2017 年 8 月 31 日期间，在美国 49 家医院住院的，临床培养物对 CDC 定义的 CRE 呈阳性的患者均纳入研究。无年龄排除。主要结局是 30 天后指数培养物的理想结局排名（DOOR）。收集临床数据和细菌，并进行全基因组测序。本试验在 ClinicalTrials.gov 注册，编号为 NCT03646227。
纳入了 1040 例具有独特分离株的患者，其中 449 例（43%）为感染，591 例（57%）为定植。CDC 定义的 CRE 入院率为 57/100000（95%CI 45-71）。确定了三种 CDC 定义的 CRE 亚组：产碳青霉烯酶肠杆菌科（1040 例中的 618 例[59%]）、非产碳青霉烯酶肠杆菌科（194 例[19%]）和未确认的 CRE（228 例[22%]；最初报告为 CRE，但在两个中心实验室对碳青霉烯类药物敏感）。产肺炎克雷伯菌碳青霉烯酶的 258 型肺炎克雷伯菌是最常见的产碳青霉烯酶肠杆菌科。在 449 例 CDC 定义的 CRE 感染患者中，产碳青霉烯酶肠杆菌科、非产碳青霉烯酶肠杆菌科和未确认的 CRE 患者的 DOOR 结局无显著差异。30 天时，这些患者中有 107 例（24%，95%CI 20-28）死亡。
在 CDC 定义的 CRE 患者中，三个亚组观察到相似的结局，包括新的未确认的 CRE 组。CDC 定义的 CRE 代表了多种细菌，其传播可能不会对针对产碳青霉烯酶肠杆菌科的干预措施产生反应。
美国国立卫生研究院。
