Pattolath Athira, Adhikari Prabha, Pai Vidya
Department of Geriatric Medicine, Yenepoya Medical College Hospital, Yenepoya Deemed to be University, Mangalore, Karnataka, India.
Department of Microbiology, Yenepoya Medical College Hospital, Yenepoya Deemed to be University, Mangalore, Karnataka, India.
Infect Drug Resist. 2023 Jul 4;16:4335-4348. doi: 10.2147/IDR.S411056. eCollection 2023.
Carbapenemase producing infection has increased in recent years, leading to limitations in treatment options. The present study was undertaken to detect the Carbapenemase-producing genes in , the risk factors for acquiring them, and their impact on clinical outcomes.
This prospective study included 786 clinically significant . isolates. Antimicrobial susceptibility testing was done by conventional method, carbapenem-resistant isolates were screened by carba NP test, and positive isolates were further evaluated by multiplex PCR method. The patient's clinical and demographic details, co morbidity, and mortality were collected. Multivariate analysis was performed to check risk factors for acquiring CRKP infection.
The results of our study showed high prevalence of CRKP (68%). The variables subjected to the multivariate analysis found that diabetes, hypertension, cardiovascular disease, COPD, use of immunosuppressants, previous hospitalization history, previous surgery, and parenteral nutrition are found to be significantly associated with carbapenem resistant infection. Clinical outcomes revealed that patients in the CRKP group had higher risk of mortality and were discharged against medical advice, and they also had higher rate of septic shock. Most of the isolates carried blaNDM-1 and blaOXA-48 carbapenemase genes. Additionally, the co-existence of blaNDM-1 and blaOXA-48 was found in our isolates.
The prevalence of CRKP was alarmingly high in our hospital with the limited choice of antibiotics. This was associated with high mortality and morbidity with the increase in health care burden. While this information is important to treat critically ill patients with higher antibiotics, strict infection control practices need to be in place to prevent the spread of these infections in the hospital. Clinicians need to be aware of this infection to use appropriate antibiotics to save the lives of critically ill patients with the infection.
近年来，产碳青霉烯酶感染有所增加，导致治疗选择受限。本研究旨在检测产碳青霉烯酶基因、获取这些基因的危险因素及其对临床结局的影响。
这项前瞻性研究纳入了786株具有临床意义的[具体研究对象]分离株。采用常规方法进行药敏试验，对耐碳青霉烯类分离株进行碳青霉烯酶检测（Carba NP试验），对阳性分离株进一步采用多重聚合酶链反应（PCR）方法进行评估。收集患者的临床和人口统计学详细信息、合并症及死亡率。进行多变量分析以检查获得耐碳青霉烯类肺炎克雷伯菌（CRKP）感染的危险因素。
我们的研究结果显示CRKP的患病率很高（68%）。多变量分析的变量发现，糖尿病、高血压、心血管疾病、慢性阻塞性肺疾病（COPD）、使用免疫抑制剂、既往住院史、既往手术史及肠外营养与耐碳青霉烯类感染显著相关。临床结局显示，CRKP组患者的死亡风险更高，且多为医嘱出院，感染性休克发生率也更高。大多数分离株携带blaNDM - 1和blaOXA - 48碳青霉烯酶基因。此外，我们的分离株中还发现了blaNDM - 1和blaOXA - 48的共存情况。
我院CRKP的患病率高得惊人，且抗生素选择有限。这与高死亡率和高发病率相关，增加了医疗负担。虽然这些信息对于使用更高级抗生素治疗重症患者很重要，但需要严格实施感染控制措施以防止这些感染在医院内传播。临床医生需要了解这种感染，以便使用适当的抗生素挽救感染重症患者的生命。
