Chen Yen-Chou, Tsai I-Ting, Lai Chung-Hsu, Lin Kuo-Hsuan, Hsu Yin-Chou
Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan.
School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan.
Antibiotics (Basel). 2024 Mar 20;13(3):282. doi: 10.3390/antibiotics13030282.
The increasing prevalence of carbapenem-resistant (CRKP) infections is a global concern. Elderly patients have a diminished immune response and functional reserve, and are thus more vulnerable to bacterial infection. This study aimed to investigate the risk factors and outcomes in elderly patients with community-acquired CRKP infections. We performed a retrospective cohort study in a tertiary medical center between 1 January 2021, and 31 December 2021. All elderly patients who visited the emergency department during this period with culture-positive were enrolled, and their baseline demographics, laboratory profiles, management strategies, and outcomes were recorded and analyzed. We identified 528 elderly patients with infection, and the proportion of patients with CRKP infection was 10.2% (54/528). Recent intensive care unit (ICU) admission and prior carbapenem use are independent risk factors for CRKP infection in elderly patients. Compared to patients with carbapenem-sensitive infection, those with CRKP infection had a significantly higher risk of adverse outcomes, including ICU care, respiratory failure, septic shock, and 90-day mortality. CRKP infection was also identified as an independent risk factor for 90-day mortality. Clinicians should be aware of the increasing prevalence of CRKP infections in elderly patients and judiciously choose appropriate antibiotics for these patients.
耐碳青霉烯类肺炎克雷伯菌（CRKP）感染的患病率不断上升，这是一个全球关注的问题。老年患者的免疫反应和功能储备有所下降，因此更容易受到细菌感染。本研究旨在调查老年社区获得性CRKP感染患者的危险因素及预后情况。我们于2021年1月1日至2021年12月31日在一家三级医疗中心进行了一项回顾性队列研究。纳入在此期间因培养结果呈阳性而到急诊科就诊的所有老年患者，并记录和分析他们的基线人口统计学资料、实验室检查结果、治疗策略及预后情况。我们确定了528例感染老年患者，其中CRKP感染患者的比例为10.2%（54/528）。近期入住重症监护病房（ICU）和既往使用碳青霉烯类药物是老年患者发生CRKP感染的独立危险因素。与碳青霉烯类敏感感染患者相比，CRKP感染患者出现不良预后的风险显著更高，包括接受ICU治疗、呼吸衰竭、感染性休克和90天死亡率。CRKP感染也被确定为90天死亡率的独立危险因素。临床医生应意识到老年患者中CRKP感染的患病率不断上升，并谨慎地为这些患者选择合适的抗生素。
