Demographic, clinical, and outcome characteristics of carbapenem-resistant Enterobacteriaceae over a 10-year period (2010-2020) in Oman.

PURPOSE

The incidence of carbapenem-resistant Enterobacteriaceae (CRE) has increased in the last two decades, causing significant morbidity and mortality. Our study investigated the factors associated with mortality from CRE bloodstream infection in a single center in Oman.

METHODS

Data from adult patients with CRE bacteremia, over a 10-year period, were retrospectively collected. Demographic and clinical characteristics were compared according to intensive care unit (ICU) admission status and mortality. A logistic regression model was used to evaluate factors associated with mortality.

RESULTS

169 cases of CRE bacteremia were identified, of whom 93 (55%) required ICU admission and 96 (56.8%) died. Patients who required ICU care were more likely to require organ transplant (15% vs 4.0%;  = 0.02), be on immunosuppressants (31% vs 17%;  = 0.035), be transferred from other hospitals (40% vs 14%; < 0.001), be colonized with CRE (73% vs 43%; < 0.001), have vascular lines (85% vs 42%; < 0.001), be on mechanical ventilation (91% vs 9.2%; < 0.001), require a longer stay (37 vs 17 days; < 0.001), and have increased mortality (80% vs 29%; < 0.001). In the multivariate analysis, mechanical ventilation (adjusted odds ratio (aOR) 15.3; 95% confidence interval 5.39-43.2; < 0.001) and prior use of the broad-spectrum antibiotics meropenem ( = 0.01) and piperacillin/tazobactam ( = 0.026) were associated with CRE mortality.

CONCLUSION

CRE bacteremia carries a high mortality rate in patients requiring ICU care. Implementation of infection control measures and antimicrobial stewardship programs are essential in reducing the rates of CRE BSI.