Antequera M Alba, Sáez B Carmen, Ciudad S Marianela, García B María José, Moyano V Berta, Rodríguez C Pablo, Roy V Emilia, Aguilera G María, Alonso N Ester, Cárdenas I María José, Castro G Sara, Domingo G Diego, Barrios B Ana
Servicio Medicina Interna-Infecciosas, Hospital Universitario La Princesa, Madrid, España.
Servicio de Microbiología, Hospital Universitario La Princesa, Madrid, España.
Rev Chilena Infectol. 2020 Jun;37(3):295-303. doi: 10.4067/s0716-10182020000300295.
Carbapenemase-producing Enterobacteriaceae (CPE) has become a significant problem in terms of public health and clinical outcome.
To assess the epidemiology, treatment and mortality in patients with infection due to CPE.
A retrospective analysis of 163 patients with CPE infection was carried out in a university hospital from July 2013 to October 2015.
A total of 163 patients were included over the study period. Klebsiella pneumoniae was isolated in 95.1% of cases, and most of carbapenemases belonged to the OXA-48 group (93.0%). Acquisition was nosocomial in 124 cases (77.0%), healthcare-associated in 30 (18.6%), and 7 cases (4.3%) were community-acquired. The most frequent infections identified in this study were urinary tract (48.4%) and respiratory (19.5%) infections. Approximately half of the patients received antibiotic monotherapy. The 30-day mortality rate was 23.3%. Multivariate analysis revealed that the presence of septic shock at diagnosis (OR 4.2; IC 95% 1.5-11) was independently associated with an increase in death during the first month, unable to identify association with inappropriate antibiotic treatment.
Further studies are needed to clarify whether antibiotic treatment of EPC infections should be combined or if monotherapy might be sufficient in mild infections.
产碳青霉烯酶肠杆菌科细菌（CPE）已成为一个严重的公共卫生和临床问题。
评估CPE感染患者的流行病学、治疗及死亡率。
对2013年7月至2015年10月在一所大学医院的163例CPE感染患者进行回顾性分析。
研究期间共纳入163例患者。95.1%的病例分离出肺炎克雷伯菌，且大多数碳青霉烯酶属于OXA - 48组（93.0%）。124例（77.0%）为医院获得性感染，30例（18.6%）为医疗保健相关感染，7例（4.3%）为社区获得性感染。本研究中最常见的感染是尿路感染（48.4%）和呼吸道感染（19.5%）。约一半的患者接受了抗生素单药治疗。30天死亡率为23.3%。多因素分析显示，诊断时存在感染性休克（比值比4.2；95%置信区间1.5 - 11）与第一个月内死亡增加独立相关，未发现与不适当抗生素治疗有关联。
需要进一步研究以明确CPE感染的抗生素治疗是否应联合使用，或者单药治疗对轻度感染是否可能足够。
