King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
Alfaisal University, Riyadh, Saudi Arabia.
BMC Infect Dis. 2022 Jun 13;22(1):542. doi: 10.1186/s12879-022-07507-y.
The burden of carbapenem resistance is not well studied in the Middle East. We aimed to describe the molecular epidemiology and outcome of carbapenem-resistant Enterobacterales (CRE) infections from several Saudi Arabian Centers.
This is a multicenter prospective cohort study conducted over a 28-month period. Patients older than 14 years of age with a positive CRE Escherichia coli or Klebsiella pneumoniae culture and a clinically established infection were included in this study. Univariate and multivariable logistic models were constructed to assess the relationship between the outcome of 30-day all-cause mortality and possible continuous and categorical predictor variables.
A total of 189 patients were included. The median patient age was 62.8 years and 54.0% were male. The most common CRE infections were nosocomial pneumonia (23.8%) and complicated urinary tract infection (23.8%) and 77 patients (40.7%) had CRE bacteremia. OXA-48 was the most prevalent gene (69.3%). While 100 patients (52.9%) had a clinical cure, 57 patients (30.2%) had died within 30 days and 23 patients (12.2%) relapsed. Univariate analysis to predict 30-day mortality revealed that the following variables are associated with mortality: older age, high Charlson comorbidity index, increased Pitt bacteremia score, nosocomial pneumonia, CRE bacteremia and diabetes mellitus. In multivariable analysis, CRE bacteremia remained as an independent predictor of 30 day all-cause mortality [AOR and 95% CI = 2.81(1.26-6.24), p = 0.01].
These data highlight the molecular epidemiology and outcomes of CRE infection in Saudi Arabia and will inform future studies to address preventive and management interventions.
在中东，碳青霉烯类耐药的负担尚未得到充分研究。我们旨在描述来自沙特阿拉伯几个中心的碳青霉烯类耐药肠杆菌科（CRE）感染的分子流行病学和结果。
这是一项为期 28 个月的多中心前瞻性队列研究。纳入年龄大于 14 岁且具有阳性 CRE 大肠埃希菌或肺炎克雷伯菌培养和临床确诊感染的患者。采用单变量和多变量逻辑模型来评估 30 天全因死亡率的结果与可能的连续和分类预测变量之间的关系。
共纳入 189 例患者。患者的中位年龄为 62.8 岁，54.0%为男性。最常见的 CRE 感染是医院获得性肺炎（23.8%）和复杂性尿路感染（23.8%），77 例（40.7%）患者发生 CRE 菌血症。最常见的基因是 OXA-48（69.3%）。虽然 100 例（52.9%）患者临床治愈，但 57 例（30.2%）在 30 天内死亡，23 例（12.2%）复发。预测 30 天死亡率的单变量分析显示，以下变量与死亡率相关：年龄较大、较高的 Charlson 合并症指数、增加的 Pitt 菌血症评分、医院获得性肺炎、CRE 菌血症和糖尿病。多变量分析显示，CRE 菌血症仍然是 30 天全因死亡率的独立预测因素[优势比和 95%置信区间=2.81（1.26-6.24），p=0.01]。
这些数据突出了沙特阿拉伯 CRE 感染的分子流行病学和结果，并将为未来的研究提供信息，以解决预防和管理干预措施。
