耐碳青霉烯类肠杆菌科细菌感染的危险因素：一项国际配对病例对照研究（EURECA）
Risk factors for infections caused by carbapenem-resistant Enterobacterales: an international matched case-control-control study (EURECA).
作者信息
Pérez-Galera Salvador, Bravo-Ferrer Jose M, Paniagua María, Kostyanev Tomislav, de Kraker Marlieke E A, Feifel Jan, Sojo-Dorado Jesús, Schotsman Joost, Cantón Rafael, Daikos George L, Carevic Biljana, Dragovac Gorana, Tan Lionel K, Raka Lul, Hristea Adriana, Viale Pierluigi, Akova Murat, Reguera Jose María, Valiente de Santis Lucía, Torre-Cisneros Julián, Cano Ángela, Roilides Emmanuel, Radulovic Lili, Kirakli Cenk, Shaw Evelyn, Falagas Matthew E, Pintado Vicente, Goossens Herman, Bonten Marc J, Gutiérrez-Gutiérrez Belén, Rodriguez-Baño Jesús
机构信息
Unidad de Enfermedades y Microbiología, Hospital Universitario Virgen Macarena and Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla/CSIC, Seville, Spain.
Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Seville, Spain.
出版信息
EClinicalMedicine. 2023 Feb 27;57:101871. doi: 10.1016/j.eclinm.2023.101871. eCollection 2023 Mar.
BACKGROUND
Data on risk factors for carbapenem-resistant Enterobacterales (CRE) with wider applicability are needed to inform preventive measures and efficient design of randomised trials.
METHODS
An international matched case-control-control study was performed in 50 hospitals with high CRE incidence from March 2016 to November 2018 to investigate different aspects of infections caused by CRE (NCT02709408). Cases were patients with complicated urinary tract infection (cUTI), complicated intraabdominal (cIAI), pneumonia or bacteraemia from other sources (BSI-OS) due to CRE; control groups were patients with infection caused by carbapenem-susceptible Enterobacterales (CSE), and by non-infected patients, respectively. Matching criteria included type of infection for CSE group, ward and duration of hospital admission. Conditional logistic regression was used to identify risk factors.
FINDINGS
Overall, 235 CRE case patients, 235 CSE controls and 705 non-infected controls were included. The CRE infections were cUTI (133, 56.7%), pneumonia (44, 18.7%), cIAI and BSI-OS (29, 12.3% each). Carbapenemase genes were found in 228 isolates: OXA-48/like, 112 (47.6%), KPC, 84 (35.7%), and metallo-β-lactamases, 44 (18.7%); 13 produced two. The risk factors for CRE infection in both type of controls were (adjusted OR for CSE controls; 95% CI; p value) previous colonisation/infection by CRE (6.94; 2.74-15.53; <0.001), urinary catheter (1.78; 1.03-3.07; 0.038) and exposure to broad spectrum antibiotics, as categorical (2.20; 1.25-3.88; 0.006) and time-dependent (1.04 per day; 1.00-1.07; 0.014); chronic renal failure (2.81; 1.40-5.64; 0.004) and admission from home (0.44; 0.23-0.85; 0.014) were significant only for CSE controls. Subgroup analyses provided similar results.
INTERPRETATION
The main risk factors for CRE infections in hospitals with high incidence included previous colonization, urinary catheter and exposure to broad spectrum antibiotics.
FUNDING
The study was funded by the Innovative Medicines Initiative Joint Undertaking (https://www.imi.europa.eu/) under Grant Agreement No. 115620 (COMBACTE-CARE).
背景
需要具有更广泛适用性的耐碳青霉烯类肠杆菌科细菌（CRE）危险因素数据，以指导预防措施和随机试验的有效设计。
方法
2016年3月至2018年11月，在50家CRE发病率高的医院进行了一项国际配对病例对照研究，以调查CRE引起感染的不同方面（NCT02709408）。病例为因CRE导致复杂性尿路感染（cUTI）、复杂性腹腔内感染（cIAI）、肺炎或其他来源菌血症（BSI-OS）的患者；对照组分别为碳青霉烯类敏感肠杆菌科细菌（CSE）引起感染的患者和未感染患者。配对标准包括CSE组的感染类型、病房和住院时间。采用条件逻辑回归来识别危险因素。
结果
共纳入235例CRE病例患者、235例CSE对照和705例未感染对照。CRE感染为cUTI（133例，56.7%）、肺炎（44例，18.7%）、cIAI和BSI-OS（各29例，12.3%）。在228株分离菌中发现了碳青霉烯酶基因：OXA-48/样，112株（47.6%），KPC，84株（35.7%），金属β-内酰胺酶，44株（18.7%）；13株产生两种酶。两种对照类型中CRE感染的危险因素为（CSE对照的调整OR；95%CI；p值）既往CRE定植/感染（6.94；2.74 - 15.53；<0.001）、导尿管（1.78；1.03 - 3.07；0.038）以及暴露于广谱抗生素，分类变量（2.20；1.25 - 3.88；0.006）和时间依赖性变量（每天1.04；1.00 - 1.07；0.014）；慢性肾衰竭（2.81；1.40 - 5.64；图0.004）和居家入院（0.44；0.23 - 0.85；0.014）仅对CSE对照有显著意义。亚组分析提供了类似结果。
解读
高发病率医院中CRE感染的主要危险因素包括既往定植、导尿管和暴露于广谱抗生素。
资助
本研究由创新药物倡议联合事业（https://www.imi.europa.eu/）根据第115620号资助协议（COMBACTE-CARE）资助。
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