产 KPC 和 NDM 肠杆菌科细菌感染患者的临床结局比较：一项回顾性队列研究。
Comparison of clinical outcomes of patients infected with KPC- and NDM-producing Enterobacterales: a retrospective cohort study.
机构信息
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
出版信息
Clin Microbiol Infect. 2021 Aug;27(8):1167.e1-1167.e8. doi: 10.1016/j.cmi.2020.09.043. Epub 2020 Sep 30.
OBJECTIVES
We aimed to compare clinical outcomes of patients with Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacterales and those with New Delhi metallo-β-lactamase (NDM)-producing Enterobacterales.
METHODS
We performed a retrospective cohort study of all adult patients with KPC- or NDM-producing Enterobacterales isolates in a 2700-bed tertiary referral hospital in Seoul, South Korea, between 2010 and 2019. The primary outcome was 30-day mortality after first isolation of KPC- or NDM-producing Enterobacterales. The secondary outcome was the development of infection within 30 days by the colonizing isolates, among colonized patients. We performed Cox regression analysis for 30-day mortality and competing risk analysis for development of infection.
RESULTS
A total of 859 patients were identified during the study period; 475 (55%) had KPC and 384 (45%) had NDM. Thirty-day mortality was significantly higher in the KPC group than in the NDM group (17% (81/475) vs 9% (33/384); p < 0.001). The KPC group developed infection within 30 days from the initial colonization after first isolation more frequently than the NDM group (8% (27/353) vs. 3% (10/295); p 0.02). Multivariable analysis revealed that independent risk factors for 30-day mortality were solid cancer (adjusted hazard ratio (aHR) 2.51; 95% confidence interval (CI) 1.66-3.79; p < 0.001), solid organ transplant (aHR 0.32; 95% CI 0.17-0.61; p < 0.001), a high APACHE II score (aHR 1.11; 95% CI 1.08-1.13; p < 0.001), KPC-producing Enterobacterales (aHR 1.69; 95% CI 1.02-2.79; p 0.04), previous carbapenem use within 3 months (aHR 1.86; 95% CI 1.26-2.75; p < 0.001) and site of KPC- or NDM-producing Enterobacterales infection at the time of the first culture (p < 0.001).
DISCUSSION
Our study suggests that KPC-producing Enterobacterales is significantly associated with poorer outcomes than NDM-producing Enterobacterales.
目的
本研究旨在比较产肺炎克雷伯菌碳青霉烯酶（KPC）肠杆菌科和产新德里金属β-内酰胺酶（NDM）肠杆菌科患者的临床结局。
方法
我们对韩国首尔一家 2700 床位的三级转诊医院 2010 年至 2019 年间所有成人 KPC 或 NDM 产肠杆菌科分离株患者进行了回顾性队列研究。主要结局为首次分离出 KPC 或 NDM 产肠杆菌科后 30 天的死亡率。次要结局为定植患者中定植分离株在 30 天内发生感染的情况。我们对 30 天死亡率进行 Cox 回归分析，对感染发生进行竞争风险分析。
结果
研究期间共确定了 859 例患者；475 例（55%）为 KPC 组，384 例（45%）为 NDM 组。KPC 组的 30 天死亡率明显高于 NDM 组（17%（81/475）vs. 9%（33/384）；p<0.001）。KPC 组在首次分离后 30 天内从初始定植中发生感染的频率明显高于 NDM 组（8%（27/353）vs. 3%（10/295）；p<0.02）。多变量分析显示，30 天死亡率的独立危险因素包括实体瘤（调整后危险比（aHR）2.51；95%置信区间（CI）1.66-3.79；p<0.001）、实体器官移植（aHR 0.32；95% CI 0.17-0.61；p<0.001）、高急性生理学与慢性健康状况评分系统 II 评分（aHR 1.11；95% CI 1.08-1.13；p<0.001）、产 KPC 肠杆菌科（aHR 1.69；95% CI 1.02-2.79；p<0.04）、在首次培养前 3 个月内使用过碳青霉烯类药物（aHR 1.86；95% CI 1.26-2.75；p<0.001）以及 KPC 或 NDM 产肠杆菌科感染部位（p<0.001）。
讨论
本研究表明，产 KPC 肠杆菌科与产 NDM 肠杆菌科相比，其预后明显较差。
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