Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
Int J Antimicrob Agents. 2023 Nov;62(5):106959. doi: 10.1016/j.ijantimicag.2023.106959. Epub 2023 Aug 24.
Due to high mortality and limited treatment options, the rise in carbapenemase-producing Enterobacterales (CPE) has become a major concern. This study aimed to evaluate the incidence and characteristics of subsequent CPE bacteraemia in rectal CPE carriers and investigate the risk factors for CPE bacteraemia compared with non-carbapenemase-producing (non-CP) Enterobacterales bacteraemia.
A retrospective analysis was conducted on adult patients who were confirmed to have CPE colonisation by stool surveillance culture at a tertiary hospital from January 2018 to February 2022. All episodes of Enterobacterales bacteraemia up to 6 months after CPE colonisation were identified.
Of 1174 patients identified as rectal CPE carriers, 69 (5.8%; 95% CI 4.6-7.3%) experienced subsequent CPE bacteraemia during the 6 months after the diagnosis of CPE colonisation. Colonisation by a Klebsiella pneumoniae carbapenemase (KPC) producer (or CP-K. pneumoniae), colonisation by multiple CPE species, chronic kidney disease and haematological malignancy were independently associated with CPE bacteraemia in CPE carriers. When CPE carriers developed Enterobacterales bacteraemia, the causative agent was more frequently non-CP Enterobacterales than CPE (63.6% vs. 36.4%). Among these patients, colonisation with a KPC producer, CPE colonisation at multiple sites, shorter duration from colonisation to bacteraemia (< 30 days) and recent intraabdominal surgery were independent risk factors for CPE bacteraemia rather than non-CP Enterobacterales bacteraemia.
In CPE carriers, non-CP Enterobacterales were more often responsible for bacteraemia than CPE. Empirical antibiotic therapy for CPE should be considered when sepsis is suspected in a CPE carrier with risk factors for CPE bacteraemia.
由于高死亡率和有限的治疗选择，产碳青霉烯酶肠杆菌科（CPE）的增加已成为一个主要关注点。本研究旨在评估直肠 CPE 定植者中随后发生的 CPE 菌血症的发生率和特征，并研究与非产碳青霉烯酶（非 CP）肠杆菌科菌血症相比，CPE 菌血症的危险因素。
对 2018 年 1 月至 2022 年 2 月在一家三级医院通过粪便监测培养确认为 CPE 定植的成年患者进行回顾性分析。确定 CPE 定植后 6 个月内所有肠杆菌科菌血症的发作。
在 1174 例被确定为直肠 CPE 定植者中，69 例（5.8%；95%CI 4.6-7.3%）在 CPE 定植后 6 个月内发生随后的 CPE 菌血症。产碳青霉烯酶肺炎克雷伯菌（KPC）的定植（或 CP-K. pneumoniae）、多种 CPE 种定植、慢性肾脏病和血液系统恶性肿瘤与 CPE 定植者的 CPE 菌血症独立相关。当 CPE 定植者发生肠杆菌科菌血症时，病原体更常是非 CP 肠杆菌科而不是 CPE（63.6%比 36.4%）。在这些患者中，KPC 产酶菌定植、多个部位 CPE 定植、从定植到菌血症的时间较短（<30 天）和近期腹腔内手术是 CPE 菌血症而不是非 CP 肠杆菌科菌血症的独立危险因素。
在 CPE 定植者中，非 CP 肠杆菌科引起的菌血症比 CPE 更常见。对于具有 CPE 菌血症危险因素的 CPE 定植者，如果怀疑发生败血症，应考虑经验性抗生素治疗 CPE。
