Yoo Eun Hyung, Hong Hyo-Lim, Kim Eun Jin
Department of Laboratory Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.
Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.
Infect Drug Resist. 2023 Jan 7;16:189-200. doi: 10.2147/IDR.S391409. eCollection 2023.
The prevalence of carbapenem-resistant Enterobacterales (CRE) is rapidly increasing worldwide. Patients in the intensive care unit (ICU) are susceptible to CRE infections, and the related mortality rate is increased. It is necessary to understand CRE strains and risk factors for CRE infection in the ICU, to facilitate development of effective prophylactic strategies and treatments for ICU patients.
This observational study was conducted in a tertiary hospital between 2016 and 2021. The subjects were patients with CRE cultured from specimens obtained after ICU admission. Genotypes of strains of CRE and carbapenemase-producing Enterobacterales (CPE) were identified, CRE infection was distinguished from mere colonization, and the clinical course of these patients was investigated.
Among 327 CRE cases, 84 (25.7%) showed infection and 243 (74.3%) showed colonization. Of these patients, 138 (42.2%) died. The CRE strains were (253 cases, 77.4%), (44 cases, 13.5%), and (15 cases, 4.6%). Among CRE cases, CPE was found in 249 (76.1%), including carbapenemase (KPC) in 164 (65.9%), and Guiana extended-spectrum (GES) in 64 (25.7%). A bedridden state, longer ICU stay, chronic kidney disease, malignancy, connective tissue disease, ICU admission for cardiac arrest, and CRE infection were associated with higher mortality, but cerebrovascular disease and ICU admission for trauma were associated with lower mortality. GES outbreak was caused by person-to-person transmission and was controlled through active surveillance.
The frequency of and KPC was the highest, but and GES was characteristically high in this study. Active CRE surveillance can be helpful for controlling outbreak.
耐碳青霉烯类肠杆菌科细菌（CRE）在全球的流行率正在迅速上升。重症监护病房（ICU）的患者易感染CRE，且相关死亡率增加。有必要了解ICU中CRE菌株及CRE感染的危险因素，以促进制定针对ICU患者的有效预防策略和治疗方法。
本观察性研究于2016年至2021年在一家三级医院进行。研究对象为入住ICU后从标本中培养出CRE的患者。鉴定了CRE菌株和产碳青霉烯酶肠杆菌科细菌（CPE）的基因型，区分了CRE感染与单纯定植，并对这些患者的临床病程进行了调查。
在327例CRE病例中，84例（25.7%）为感染，243例（74.3%）为定植。这些患者中，138例（42.2%）死亡。CRE菌株以[具体菌株1]（253例，77.4%）、[具体菌株2]（44例，13.5%）和[具体菌株3]（15例，4.6%）为主。在CRE病例中，249例（76.1%）检测到CPE，其中164例（65.9%）为产KPC碳青霉烯酶，64例（25.7%）为产圭亚那扩展谱酶（GES）。卧床状态、ICU住院时间延长、慢性肾脏病、恶性肿瘤、结缔组织病、因心脏骤停入住ICU以及CRE感染与较高死亡率相关，但脑血管疾病和因创伤入住ICU与较低死亡率相关（此处原文中“but cerebrovascular disease and ICU admission for trauma were associated with lower mortality”前面的“but”使用不当，根据语境推测可能是“and”）。GES暴发是由人际传播引起的，并通过主动监测得到了控制。
在本研究中，[具体菌株1]和KPC的出现频率最高，但[具体菌株2]和GES的出现频率也显著较高。积极的CRE监测有助于控制暴发。 （注：原文中部分菌株名称未给出具体中文翻译，保留了英文，需根据实际情况补充完整）
