Department of Infectious and Tropical Diseases, Hôpitaux Universitaires de Strasbourggrid.412220.7, Strasbourg, France.
Service d'Hygiène Hospitalière, Hôpitaux Universitaires de Strasbourggrid.412220.7, Strasbourg, France.
Microbiol Spectr. 2022 Dec 21;10(6):e0186822. doi: 10.1128/spectrum.01868-22. Epub 2022 Nov 2.
This study aimed to assess the proportion of carbapenemase-producing Enterobacterales (CPE) infections among all infectious episodes in CPE carriers, compare the time-to-onset of CPE infections with that of other infections, assess the mortality of patients with CPE infections, and identify risk factors for CPE infections in CPE carriers. A retrospective cohort study was performed over a 10-year period in our University Hospital, and 274 CPE carriers were identified. All infectious episodes within the first 6 months following the diagnosis of CPE rectal carriage were considered. Risk factor analysis for CPE infections in CPE carriers was performed by univariate and multivariate analyses. This study revealed an incidence of 24.1% (66/274) of CPE infection within 6 months of CPE carriage diagnosis. The 28-day all-cause mortality due to CPE infections was 25.7%. CPE infections represented 52.6% (70/133) of all infectious episodes in CPE carriers in the first 6 months following CPE carriage detection, and these significantly occurred earlier than non-CPE infections, with a median time of 15 versus 51 days, respectively ( < 0.01). Based on the multivariate analysis, prior neurological disease was the only risk factor associated with CPE infections in CPE carriers. CPE infections have an early onset, accounting for a large proportion of infections in CPE carriers, and are associated with high mortality. Carbapenemase-producing Enterobacterales (CPE) infections are emerging infections and may represent a therapeutic challenge, while effective antibiotic therapy is likely to be delayed. We aimed to assess the proportion of CPE infections in CPE carriers and to identify risk factors of CPE infections among this population that could guide empirical antibiotic therapy. We showed that CPE infections are frequent in CPE carriers, have an early onset after CPE carriage diagnosis, and represent a significant proportion of all infectious episodes in CPE carriers. No significant risk factors for CPE infections could be identified. Overall, this study suggests that empirical antibiotic treatment covering CPE might be initiated in CPE carriers at least in the first month after its diagnosis and in severe infections due to the high frequency and early occurrence of CPE infections in these patients.
本研究旨在评估产碳青霉烯酶肠杆菌科（CPE）感染在 CPE 定植者所有感染发作中的比例，比较 CPE 感染与其他感染的发病时间，评估 CPE 感染患者的死亡率，并确定 CPE 定植者中 CPE 感染的危险因素。我们对我院 10 年来的一项回顾性队列研究进行了研究，共确定了 274 名 CPE 定植者。所有感染发作均发生在 CPE 直肠定植后 6 个月内。通过单因素和多因素分析对 CPE 定植者中 CPE 感染的危险因素进行了分析。本研究显示，在 CPE 定植后 6 个月内，CPE 感染的发生率为 24.1%（66/274）。由于 CPE 感染，28 天的全因死亡率为 25.7%。在 CPE 定植后 6 个月内，CPE 定植者中所有感染发作的 52.6%（70/133）为 CPE 感染，这些感染明显早于非 CPE 感染，中位时间分别为 15 天和 51 天（<0.01）。基于多因素分析，既往神经系统疾病是 CPE 定植者中 CPE 感染的唯一危险因素。CPE 感染发病早，占 CPE 定植者感染的很大比例，死亡率高。产碳青霉烯酶肠杆菌科（CPE）感染是一种新出现的感染，可能代表一种治疗挑战，而有效的抗生素治疗可能会延迟。我们旨在评估 CPE 定植者中的 CPE 感染比例，并确定该人群中 CPE 感染的危险因素，以指导经验性抗生素治疗。我们发现，CPE 定植者中 CPE 感染较为常见，在 CPE 定植诊断后发病早，且占 CPE 定植者所有感染发作的很大比例。未发现 CPE 感染的显著危险因素。总体而言，本研究表明，在 CPE 诊断后至少在第一个月内，以及在这些患者因感染严重时，可对 CPE 定植者进行覆盖 CPE 的经验性抗生素治疗，因为这些患者中 CPE 感染的频率高且发病早。
