Infectious Diseases Unit, Internal Medicine, Complexo Hospitalario Universitario de Vigo, Estrada Clara Campoamor, 341 Pontevedra, 36213, Vigo, Spain.
Biomedical Research Institute Galicia Sur, Vigo, Spain.
Eur J Clin Microbiol Infect Dis. 2022 Dec;41(12):1399-1405. doi: 10.1007/s10096-022-04504-6. Epub 2022 Oct 7.
Carbapenem-resistant Enterobacterales (CRE) infections are a major health problem. Intestinal colonization is a key factor in developing infection. However, factors associated with persistent colonization by CRE are unknown. The aim of the study was to identify factors associated with persistent CRE gut colonization. This is a retrospective, single-centre, observational study of adult patients with CRE gut colonization between January 2015 and January 2020. Epidemiologic characteristics, comorbidities, infectious events, duration of hospitalization and antimicrobial treatment received in the follow-up period were collected. Colonization was defined as isolation in at least 2 rectal swab culture samples of CRE. Decolonization was defined as 3 negative rectal swab cultures or 2 negative cultures and a negative molecular test. A cohort of 86 patients with CRE gut colonization was selected: 44 patients with spontaneous decolonization (DC) and 42 patients with persistent colonization (PC). The mean follow-up period was 24 months (IQR 14-33) in the DC group vs. 25 months (IQR 16-36) in the PC group (p = 0.478). Patient characteristics were similar between both groups. Colonization by other MDR microorganisms was high (44 patients, 51%) and slightly more common in the PC group (PC 60% vs. DC 43%, p = 0.139). The use of ceftazidime-avibactam was more common among the PC group (PC 33% vs. DC 14%, p = 0.041). We observed a higher percentage of antimicrobial therapy in the previous 30 days (PC 68% vs. DC 57%, p = 0.371) and 90 days (PC 81% vs. DC 82%, p = 0.353) in the PC group. Multivariable analysis showed that patients that have received ceftazidime-avibactam therapy (OR 4.9 95% CI [1.45-16.39], p = 0.010), and those colonized by other MDR microorganisms (OR 2.5, 95% CI [0.96-6.25], p = 0.060) presented a higher risk of PC. Ceftazidime-avibactam use and colonization by other MDR microorganisms might be associated with CRE persistent gut colonization.
耐碳青霉烯肠杆菌科（CRE）感染是一个主要的健康问题。肠道定植是发展感染的一个关键因素。然而，与 CRE 持续定植相关的因素尚不清楚。本研究的目的是确定与 CRE 肠道定植持续相关的因素。这是一项回顾性、单中心、观察性研究，纳入了 2015 年 1 月至 2020 年 1 月期间患有 CRE 肠道定植的成年患者。收集了流行病学特征、合并症、感染事件、住院时间和随访期间接受的抗菌治疗。定植被定义为至少 2 次直肠拭子培养分离出 CRE。去定植被定义为 3 次直肠拭子培养阴性或 2 次培养阴性和 1 次分子检测阴性。选择了 86 例 CRE 肠道定植患者：44 例自发去定植（DC）和 42 例持续定植（PC）。DC 组的中位随访时间为 24 个月（IQR 14-33），PC 组为 25 个月（IQR 16-36）（p=0.478）。两组患者特征相似。其他多重耐药微生物的定植率较高（44 例，51%），PC 组略高（PC 60% vs. DC 43%，p=0.139）。PC 组更常使用头孢他啶-阿维巴坦（PC 33% vs. DC 14%，p=0.041）。我们观察到 PC 组在前 30 天（PC 68% vs. DC 57%，p=0.371）和 90 天（PC 81% vs. DC 82%，p=0.353）接受抗菌治疗的比例更高。多变量分析显示，接受头孢他啶-阿维巴坦治疗的患者（OR 4.9，95%CI [1.45-16.39]，p=0.010）和定植其他多重耐药微生物的患者（OR 2.5，95%CI [0.96-6.25]，p=0.060）发生 PC 的风险更高。头孢他啶-阿维巴坦的使用和其他多重耐药微生物的定植可能与 CRE 肠道定植的持续存在有关。
