Tadese Bekana K, DeSantis Stacia M, Mgbere Osaro, Fujimoto Kayo, Darkoh Charles
School of Public Health, University of Texas Health Science Center, Houston, TX, USA.
Fort Bend County Health and Human Services, Texas, USA.
Infect Prev Pract. 2022 Oct 17;4(4):100255. doi: 10.1016/j.infpip.2022.100255. eCollection 2022 Dec.
Infections with carbapenem-resistant Enterobacterales (CRE) are associated with increased risk of death. Polymicrobial infections with antimicrobial-resistance may add to the burden of clinical care and patients' clinical prognosis.
To examine the impact of CRE co-infection with other multi-drug resistant organisms (MDRO) on patient clinical outcomes.
A retrospective observational study was conducted to compare the clinical outcomes of CRE patients who were co-infected with carbapenem-resistant (CRPA), multidrug-resistant (MDRA) and Methicillin-resistant (MRSA).
A total of 224 CRPA and 209 MDRA co-infections with CRE were identified from 4,236 cases from 2015-2020. The overall 90-day all-cause mortality was 21.6% but increased to 35.0% and 33.5% among patients who were co-infected with CRPA and MDRA, respectively. The odds of all-cause mortality among CRE patients who were co-infected with CRPA was twice that of patients identified with CRE alone [adjusted odds ratio (AOR) = 2.02, 95% confidence interval (CI): 1.18-3.46]. Further, the odds of all-cause mortality among CRE patients who were concomitantly identified with MRSA was more than twice that of patients who were not identified with MRSA [AOR = 2.16, 95%CI:1.31-3.56]. The clinical outcome of patients with CRE did not differ significantly depending on the presence of carbapenemase genes.
The results show that CRPA and CRE co-infections have synergistic effects on clinical outcomes. Further investigation is necessary to understand the mechanism. Screening high risk patients for concomitant antimicrobial-resistant infections may have a significant clinical impact, including effective therapies, antibiotic stewardship, and infection control policies.
耐碳青霉烯类肠杆菌科细菌（CRE）感染与死亡风险增加相关。伴有抗菌药物耐药性的混合感染可能会加重临床护理负担和患者的临床预后。
研究CRE与其他多重耐药菌（MDRO）合并感染对患者临床结局的影响。
进行一项回顾性观察研究，比较合并碳青霉烯耐药肺炎克雷伯菌（CRPA）、多重耐药鲍曼不动杆菌（MDRA）和耐甲氧西林金黄色葡萄球菌（MRSA）的CRE患者的临床结局。
在2015年至2020年的4236例病例中，共识别出224例CRPA合并CRE感染和209例MDRA合并CRE感染。总体90天全因死亡率为21.6%，但在合并CRPA和MDRA感染的患者中分别增至35.0%和33.5%。合并CRPA感染的CRE患者全因死亡几率是仅确诊为CRE患者的两倍[调整优势比（AOR）=2.02，95%置信区间（CI）：1.18 - 3.46]。此外，同时确诊为MRSA的CRE患者全因死亡几率是未确诊为MRSA患者的两倍多[AOR = 2.16，95%CI：1.31 - 3.56]。CRE患者的临床结局在是否存在碳青霉烯酶基因方面无显著差异。
结果表明，CRPA与CRE合并感染对临床结局具有协同作用。有必要进一步研究以了解其机制。对高危患者筛查合并的抗菌药物耐药感染可能会产生重大临床影响，包括有效的治疗、抗生素管理和感染控制策略。
