Kim Yong Kyun, Chang In Bok, Kim Han Sung, Song Wonkeun, Lee Seung Soon
Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Korea.
Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Korea.
J Clin Med. 2021 Jan 15;10(2):310. doi: 10.3390/jcm10020310.
Prolonged carriage of carbapenemase-producing (CPE) constitutes a substantial epidemiologic threat. This study aimed to evaluate whether the types of carbapenemase and organism can affect the duration of carriage and to evaluate the clinical factors associated with prolonged carriage. We retrospectively reviewed data for patients admitted between May 2013 and August 2018 who were identified as CPE carriers. A total of 702 patients were identified; the major types of carbapenemase and organism were Oxacillinase (OXA)-48-like ( = 480, 68.4%) and () ( = 584, 83.2%). The analyses of time to spontaneous decolonization using the Kaplan-Meier method showed that OXA-48-like and were significantly associated with prolonged carriage (log rank, = 0.001 and < 0.001). In multivariable logistic analysis to assess the risk factors for CPE prolonged carriage in the 188 patients with available follow-up culture data for 3 months, (adjusted odds ratio [aOR] 6.58; 95% confidence interval [CI], 1.05-41.27; = 0.044), CPE positive clinical specimen (aOR 11.14; 95% CI, 4.73-26.25; < 0.001), and concurrent infection (CDI) (aOR 3.98, 95% CI 1.29-12.26; = 0.016) were predictive of prolonged carriage. Our results suggest that CP- may have higher probability of prolonged carriage, while the effect of OXA-48-like CPE is inconclusive. Furthermore, patients with CP- who had positive clinical specimen or concurrent CDI can cause a vicious circle in prolonged carriage.
携带产碳青霉烯酶（CPE）的时间延长构成了重大的流行病学威胁。本研究旨在评估碳青霉烯酶类型和生物体是否会影响携带持续时间，并评估与携带时间延长相关的临床因素。我们回顾性分析了2013年5月至2018年8月期间入院的被确定为CPE携带者的患者数据。共确定了702例患者；碳青霉烯酶和生物体的主要类型为奥沙西林酶（OXA）-48样（n = 480，68.4%）和肺炎克雷伯菌（n = 584，83.2%）。使用Kaplan-Meier方法对自发清除时间的分析表明，OXA-48样和肺炎克雷伯菌与携带时间延长显著相关（对数秩检验，P = 0.001和P < 0.001）。在对188例有3个月可用随访培养数据的患者进行的多变量逻辑分析中，以评估CPE携带时间延长的危险因素，肺炎克雷伯菌（调整优势比[aOR] 6.58；95%置信区间[CI]，1.05 - 41.27；P = 0.044）、CPE阳性临床标本（aOR 11.14；95% CI，4.73 - 26.25；P < 0.001）和并发艰难梭菌感染（CDI）（aOR 3.98，95% CI 1.29 - 12.26；P = 0.016）可预测携带时间延长。我们的结果表明，肺炎克雷伯菌CPE可能有更高的携带时间延长概率，而OXA-48样CPE的影响尚无定论。此外，临床标本呈阳性或并发CDI的肺炎克雷伯菌CPE患者在携带时间延长方面可导致恶性循环。
