Chen Xia, Liu Qingnuan, Liu Wen-En, Yan Qun
Department of Clinical Laboratory, Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.
Infect Drug Resist. 2020 May 5;13:1299-1305. doi: 10.2147/IDR.S247101. eCollection 2020.
Carbapenem-resistant (CRKP) infection has become a critical clinical concern for its high mortality. Rectal carriage of CRKP has been reported playing an important role in CRKP infection; however, the extent to which carrier develops clinical CRKP infection is unclear. This study aimed to identify risk factors for developing subsequential CRKP clinical infection in rectal carriers with CRKP.
Patients were screened for rectal carriage of CRKP in a tertiary university hospital; then, rectal CRKP carriers were divided into case group (those who developed subsequential clinical infection) and control group. Demographics, comorbid conditions, invasive procedures, antimicrobial exposure and other clinical parameters of those two groups were compared and analyzed using univariate and multivariate logistic regression analyses. Antimicrobial susceptibility profile and carbapenemase phenotype/genotype of those CRKP isolates were determined. MLST was applied to elucidate the molecular epidemiology of rectal CRKP isolates and clinical infection ones.
Eight hundred and thirty-five patients were screened for rectal CRKP carriage. A total of 62 CRKP rectal carriers were identified; among them, 37.1% (23/62) developed CRKP clinical infection. CRKP isolates were resistant to most of the tested antimicrobial agents. ST11 was the dominant MLST type in rectal CRKP isolates (71.0%), and all the 23 clinical infection isolates were ST11. Multivariate analysis revealed that admission to the intensive care unit (ICU) (OR, 6.753; =0.006), being in coma condition (OR, 11.085; =0.015) and receiving central venous catheter (OR, 8.628; =0.003) were independent risk factors for progressing to subsequential CRKP infection among those rectal carriers.
This study identified independent risk factors for developing subsequential CRKP clinical infection among CRKP rectal carriers, with being in coma condition as a new finding. It would help clinician target those high-risk rectal CRKP-colonized patients for prevention of subsequential clinical infection.
耐碳青霉烯类肺炎克雷伯菌（CRKP）感染因其高死亡率已成为临床关注的重点。已有报道称CRKP的直肠携带在CRKP感染中起重要作用；然而，携带者发展为临床CRKP感染的程度尚不清楚。本研究旨在确定CRKP直肠携带者发生后续CRKP临床感染的危险因素。
在一所三级大学医院对患者进行CRKP直肠携带筛查；然后，将直肠CRKP携带者分为病例组（发生后续临床感染的患者）和对照组。采用单因素和多因素逻辑回归分析比较和分析两组患者的人口统计学、合并症、侵入性操作、抗菌药物暴露及其他临床参数。测定这些CRKP分离株的抗菌药物敏感性谱和碳青霉烯酶表型/基因型。应用多位点序列分型（MLST）阐明直肠CRKP分离株和临床感染分离株的分子流行病学。
共筛查了835例患者的直肠CRKP携带情况。共鉴定出62例CRKP直肠携带者；其中，37.1%（23/62）发生了CRKP临床感染。CRKP分离株对大多数测试抗菌药物耐药。ST11是直肠CRKP分离株中占主导地位的MLST型（71.0%），所有23例临床感染分离株均为ST11。多因素分析显示，入住重症监护病房（ICU）（比值比[OR]，6.753；P = 0.006）、昏迷状态（OR，11.085；P = 0.015）和接受中心静脉导管（OR，8.628；P = 0.003）是这些直肠携带者进展为后续CRKP感染的独立危险因素。
本研究确定了CRKP直肠携带者发生后续CRKP临床感染的独立危险因素，昏迷状态是一项新发现。这将有助于临床医生针对那些高危的直肠CRKP定植患者预防后续临床感染。
