中国术后中枢神经系统感染的碳青霉烯类耐药肠杆菌科的临床和微生物学特征。
Clinical and microbiological characteristics of carbapenem-resistant Enterobacteriaceae causing post-operative central nervous system infections in China.
机构信息
Department of Nutrition, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Neurosurgery Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
出版信息
J Glob Antimicrob Resist. 2023 Dec;35:35-43. doi: 10.1016/j.jgar.2023.08.006. Epub 2023 Aug 22.
OBJECTIVES
Postoperative central nervous system infections (PCNSIs) caused by carbapenem-resistant Enterobacteriaceae (CRE) frequently result in unfavourable outcomes. However, CRE PCNSIs have not been well described from a clinical and microbiological perspective.
METHODS
A total of 254 PCNSIs cases were included (January 2017 through June 2020), and clinical features were compared based on pathogenic classification. Cox regression analysis was performed to assess risk factors for mortality. Antibiotic susceptibility testing and whole genome sequencing were conducted on CRE isolates preserved. MLST, cgMLST, resistance genes and virulence genes were further analysed.
RESULTS
Among 254 PCNSI cases, 15.4% were caused by Enterobacteriaceae including 28 cases by CRE. The 28-day mortality rates for CRE, CSE and non-Enterobacteriaceae PCNSIs were 50.0%, 27.3%, and 7.4%, respectively. 42.9% (12/28) of the CRE PCNSIs patients achieved clinical cure, with 25.0% achieved microbiological clearance. ST11-KL64 carrying bla was dominant in CRE (17/23, 73.9%), and the 28-day mortality rate of its infection was 58.5%. Most CRKP carried rampA/rampA2 genes (17/23, 73.9%).
CONCLUSION
ST11-KL64 CRKP carrying bla dominated among CRE PCNSIs. Targeted anti-infective combination therapy based on ceftazidime/avibactam or amikacin, combined with intrathecal administration of amikacin, was found to be effective. These findings render a new insight into the clinical and microbiological landscape of CRE PCNSIs.
目的
碳青霉烯类耐药肠杆菌科（CRE）引起的术后中枢神经系统感染（PCNSI）常导致不良结局。然而，从临床和微生物学角度来看，CRE PCNSI 尚未得到很好的描述。
方法
共纳入 254 例 PCNSI 病例（2017 年 1 月至 2020 年 6 月），根据病原体分类比较临床特征。采用 Cox 回归分析评估死亡率的危险因素。对保存的 CRE 分离株进行抗生素敏感性试验和全基因组测序，并进一步分析 MLST、cgMLST、耐药基因和毒力基因。
结果
在 254 例 PCNSI 病例中，15.4%由肠杆菌科引起，包括 28 例 CRE。CRE、CSE 和非肠杆菌科 PCNSI 的 28 天死亡率分别为 50.0%、27.3%和 7.4%。42.9%（12/28）的 CRE PCNSI 患者获得临床治愈，25.0%获得微生物学清除。ST11-KL64 携带 bla 在 CRE 中占优势（17/23，73.9%），其感染的 28 天死亡率为 58.5%。大多数 CRKP 携带 rampA/rampA2 基因（17/23，73.9%）。
结论
ST11-KL64 CRE 携带 bla 在 CRE PCNSI 中占主导地位。基于头孢他啶/阿维巴坦或阿米卡星的靶向抗感染联合治疗，结合鞘内注射阿米卡星，被发现是有效的。这些发现为 CRE PCNSI 的临床和微生物学特征提供了新的见解。
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