Department of Pharmacy, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA.
Division of Infectious Diseases, University of Rochester Medical Center, Rochester, NY, USA.
Ann Pharmacother. 2023 Jul;57(7):803-812. doi: 10.1177/10600280221132019. Epub 2022 Oct 21.
Carbapenem-resistant Enterobacterales (CRE) are difficult to treat and can cause significant morbidity and mortality, however most data reflect carbapenemase-producing infections.
Our objective was to evaluate clinical outcomes of non-carbapenemase-producing CRE (nCP-CRE) compared with carbapenem-susceptible Enterobacterales (CSE) infections.
This was a retrospective, multicenter, observational study (January 1, 2018 to December 31, 2020). The primary outcome was clinical success at 30 days with secondary outcomes, including clinical success at 90 days, clinical success based on treatment for nCP-CRE, persistent bacteremia, intensive care unit (ICU) admission, length of stay, and rate of or multidrug resistant infections.
The final analysis included 211 patients: 142 (67%) with CSE and 69 (33%) with nCP-CRE infections. Prior carbapenem exposure was more common with nCP-CRE (15% vs 4%, = 0.01). Clinical success at 30 days was similar between groups (77% vs 74%, = 0.73). There were no differences in secondary outcomes. There was an overall low use of carbapenems (empiric 6%, definitive 7%). Most nCP-CRE infections were treated with a monotherapy carbapenem-sparing regimen (empiric 88%, definitive 90%). Limitations include the retrospective design and the high rate of urinary infections.
Our study found no difference in clinical outcomes between nCP-CRE and CSE infections. Application of this study with future studies would help in determining optimal regimens for these infections.
耐碳青霉烯肠杆菌科（CRE）治疗困难，可导致严重发病率和死亡率，但大多数数据反映的是产碳青霉烯酶的感染。
我们的目的是评估非产碳青霉烯酶耐碳青霉烯肠杆菌科（nCP-CRE）与碳青霉烯敏感肠杆菌科（CSE）感染的临床结局。
这是一项回顾性、多中心、观察性研究（2018 年 1 月 1 日至 2020 年 12 月 31 日）。主要结局是 30 天临床成功率，次要结局包括 90 天临床成功率、基于 nCP-CRE 治疗的临床成功率、持续性菌血症、重症监护病房（ICU）入住、住院时间和率或多重耐药感染。
最终分析包括 211 例患者：142 例（67%）为 CSE，69 例（33%）为 nCP-CRE 感染。nCP-CRE 组更常出现碳青霉烯类药物暴露（15% vs 4%，=0.01）。两组 30 天临床成功率相似（77% vs 74%，=0.73）。次要结局无差异。总体碳青霉烯类药物使用量较低（经验性 6%，确定性 7%）。大多数 nCP-CRE 感染采用单药碳青霉烯类药物保留治疗方案（经验性 88%，确定性 90%）。局限性包括回顾性设计和尿路感染率高。
我们的研究发现 nCP-CRE 和 CSE 感染的临床结局无差异。对本研究的应用以及未来的研究将有助于确定这些感染的最佳治疗方案。
