Department of Critical Care Medicine, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical School, Wenzhou, Zhejiang, China.
J Infect Dis. 2020 Mar 16;221(Suppl 2):S156-S163. doi: 10.1093/infdis/jiz574.
Carbapenem-resistant Enterobacteriaceae (CRE) infections are associated with poor patient outcomes. Data on risk factors and molecular epidemiology of CRE in complicated intra-abdominal infections (cIAI) in China are limited. This study examined the risk factors of cIAI with CRE and the associated mortality based on carbapenem resistance mechanisms.
In this retrospective analysis, we identified 1024 cIAI patients hospitalized from January 1, 2013 to October 31, 2018 in 14 intensive care units in China. Thirty CRE isolates were genotyped to identify β-lactamase-encoding genes.
Escherichia coli (34.5%) and Klebsiella pneumoniae (21.2%) were the leading pathogens. Patients with hospital-acquired cIAI had a lower rate of E coli (26.0% vs 49.1%; P < .001) and higher rate of carbapenem-resistant Gram-negative bacteria (31.7% vs 18.8%; P = .002) than those with community-acquired cIAI. Of the isolates, 16.0% and 23.4% of Enterobacteriaceae and K pneumoniae, respectively, were resistant to carbapenem. Most carbapenemase-producing (CP)-CRE isolates carried blaKPC (80.9%), followed by blaNMD (19.1%). The 28-day mortality was 31.1% and 9.0% in patients with CRE vs non-CRE (P < .001). In-hospital mortality was 4.7-fold higher for CP-CRE vs non-CP-CRE infection (P = .049). Carbapenem-containing combinations did not significantly influence in-hospital mortality of CP and non-CP-CRE. The risk factors for 28-day mortality in CRE-cIAI included septic shock, antibiotic exposure during the preceding 30 days, and comorbidities.
Klebsiella pneumoniae had the highest prevalence in CRE. Infection with CRE, especially CP-CRE, was associated with increased mortality in cIAI.
耐碳青霉烯肠杆菌科（CRE）感染与患者预后不良有关。中国关于复杂性腹腔内感染（cIAI）中 CRE 的危险因素和分子流行病学的数据有限。本研究根据碳青霉烯类耐药机制，研究了 cIAI 中 CRE 的危险因素及其相关死亡率。
在这项回顾性分析中，我们鉴定了 2013 年 1 月 1 日至 2018 年 10 月 31 日期间在中国 14 个重症监护病房住院的 1024 例 cIAI 患者。对 30 株 CRE 分离株进行基因分型，以鉴定β-内酰胺酶编码基因。
大肠埃希菌（34.5%）和肺炎克雷伯菌（21.2%）是主要病原体。医院获得性 cIAI 患者中大肠埃希菌的发生率较低（26.0% vs. 49.1%；P <.001），耐碳青霉烯革兰氏阴性菌的发生率较高（31.7% vs. 18.8%；P =.002）。分离株中，肠杆菌科和肺炎克雷伯菌对碳青霉烯的耐药率分别为 16.0%和 23.4%。大多数产碳青霉烯酶的 CRE（CP-CRE）分离株携带 blaKPC（80.9%），其次是 blaNMD（19.1%）。CRE 患者 28 天死亡率为 31.1%，而非 CRE 患者为 9.0%（P <.001）。CP-CRE 感染患者住院死亡率是非 CP-CRE 感染的 4.7 倍（P =.049）。碳青霉烯类药物联合治疗并未显著影响 CP-CRE 和非 CP-CRE 的住院死亡率。CRE-cIAI 患者 28 天死亡率的危险因素包括感染性休克、发病前 30 天内使用抗生素以及合并症。
肺炎克雷伯菌在 CRE 中最为常见。cIAI 中 CRE 感染，尤其是 CP-CRE 感染，与死亡率增加有关。
