Disease Control and Prevention Center, National Centre for Global Health and Medicine, Tokyo, Japan
AMR Clinical Reference Center, National Centre for Global Health and Medicine, Tokyo, Japan.
Antimicrob Agents Chemother. 2021 Feb 17;65(3). doi: 10.1128/AAC.01483-20.
IMP-type carbapenemase, found in various Gram-negative bacteria, has been increasingly detected worldwide. We aimed to study the outcomes and risk factors for acquisition of IMP-type carbapenemase-producing carbapenem-resistant (IMP-CRE), as this has not been evaluated in detail. We conducted a matched case-case-control study of patients from whom IMP-CRE isolates were obtained. All patients who tested positive for IMP-CRE were included; they were matched with patients with carbapenem-susceptible (CSE) and with controls at a ratio of 1:1:2. The risk factors for acquisition for the CRE and CSE groups and mortality rates, which were calculated using multivariate logistic regression models with weighting according to the inverse probability of propensity scores, were compared. In total, 192 patients (96 patients each in the CRE and CSE groups, with 130 isolates and 62 sp. isolates) were included. The IMP-11 type was present in 43 patients, IMP-1 in 33, and IMP-60 and IMP-66 in 1 each; 31 patients with CRE (32.3%) and 34 with CSE (35.4%) developed infections. Multivariate analysis identified the following independent risk factors: gastrostomy, history of intravenous therapy or hemodialysis, and previous exposure to broad-spectrum β-lactam antibiotics, including penicillin with β-lactamase inhibitors, cephalosporins, and carbapenems. In propensity score-adjusted analysis, mortality rates for the CRE and CSE groups were similar (15.0% and 19.5%, respectively). We found that IMP-CRE may not contribute to worsened clinical outcomes, compared to CSE, and gastrostomy, previous intravenous therapy, hemodialysis, and broad-spectrum antimicrobial exposure were identified as risk factors for CRE isolation. Fluoroquinolone and aminoglycosides are potentially useful antibiotics for IMP-CRE infections.
IMP 型碳青霉烯酶存在于各种革兰氏阴性菌中，在世界范围内的检出率逐渐增高。我们旨在研究获得 IMP 型碳青霉烯酶产生的碳青霉烯耐药肠杆菌科细菌（IMP-CRE）的结果和危险因素，因为这尚未进行详细评估。我们对获得 IMP-CRE 分离株的患者进行了病例对照研究。所有 IMP-CRE 检测阳性的患者均被纳入；他们与碳青霉烯敏感（CSE）患者和对照患者以 1:1:2 的比例进行匹配。使用基于倾向评分反概率加权的多变量逻辑回归模型比较了 CRE 和 CSE 组的获得危险因素和死亡率。共纳入 192 例患者（每组 96 例，共 130 株分离株和 62 株 sp.分离株）。43 例患者存在 IMP-11 型，33 例存在 IMP-1 型，1 例存在 IMP-60 型和 IMP-66 型；31 例 CRE（32.3%）和 34 例 CSE（35.4%）患者发生感染。多变量分析确定了以下独立危险因素：胃造口术、静脉治疗或血液透析史以及先前暴露于广谱β-内酰胺类抗生素，包括青霉素与β-内酰胺酶抑制剂、头孢菌素和碳青霉烯类。在倾向评分调整分析中，CRE 和 CSE 组的死亡率相似（分别为 15.0%和 19.5%）。我们发现与 CSE 相比，IMP-CRE 可能不会导致临床结局恶化，胃造口术、先前的静脉治疗、血液透析和广谱抗菌药物暴露被确定为 CRE 分离的危险因素。氟喹诺酮类和氨基糖苷类可能是治疗 IMP-CRE 感染的有效抗生素。
