Saidel-Odes Lisa, Sagi Orli, Troib Shani, Leeman Hannah, Nativ Ronit, Schlaeffer-Yosef Tal, Azulay Hovav, Nesher Lior, Borer Abraham
Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Beer Sheba 84101, Israel.
The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba 84105, Israel.
Antibiotics (Basel). 2024 May 8;13(5):427. doi: 10.3390/antibiotics13050427.
Carbapenemase-producing enterobacterales (CPE) poses an increasing threat in hospitals worldwide. Recently, the prevalence of different carbapenemases conferring carbapenem resistance in enterobacterales changed in our country, including an increase in New Delhi Metallo-beta-lactamase (NDM)-CPE. We conducted a comparative historical study of adult patients colonized with carbapenemase (KPC)-CPE (July 2016 to June 2018, a historical cohort) vs. NDM-CPE (July 2016 to January 2023). We identified patients retrospectively through the microbiology laboratory and reviewed their files, extracting demographics, underlying diseases, Charlson Comorbidity Index (CCI) scores, treatments, and outcomes. This study included 228 consecutive patients from whom a CPE rectal swab screening was obtained: 136 NDM-CPE positive and 92 KPC-CPE positive. NDM-CPE-colonized patients had a shorter hospitalization length and a significantly lower 30-day post-discharge mortality rate ( = 0.002) than KPC-CPE-colonized patients. Based on multivariate regression, independent risk factors predicting CPE-NDM colonization included admission from home and CCI < 4 ( < 0.001, = 0.037, respectively). The increase in NDM-CPE prevalence necessitates a modified CPE screening strategy upon hospital admission tailored to the changing local CPE epidemiology. In our region, the screening of younger patients residing at home with fewer comorbidities should be considered, regardless of a prior community healthcare contact or hospital admission.
产碳青霉烯酶肠杆菌科细菌（CPE）在全球医院中构成的威胁日益增加。最近，我国肠杆菌科细菌中赋予碳青霉烯耐药性的不同碳青霉烯酶的流行情况发生了变化，包括新德里金属β-内酰胺酶（NDM）-CPE的增加。我们对2016年7月至2018年6月（一个历史队列）定植碳青霉烯酶（KPC）-CPE的成年患者与2016年7月至2023年1月定植NDM-CPE的成年患者进行了一项比较性历史研究。我们通过微生物实验室对患者进行回顾性识别，并查阅他们的病历，提取人口统计学信息、基础疾病、查尔森合并症指数（CCI）评分、治疗情况和结局。本研究纳入了228例连续接受CPE直肠拭子筛查的患者：136例NDM-CPE阳性，92例KPC-CPE阳性。与定植KPC-CPE的患者相比，定植NDM-CPE的患者住院时间更短，出院后30天死亡率显著更低（P = 0.002）。基于多变量回归分析，预测CPE-NDM定植的独立危险因素包括在家中入院和CCI < 4（分别为P < 0.001，P = 0.037）。NDM-CPE流行率的增加需要根据当地CPE流行病学的变化调整住院时的CPE筛查策略。在我们地区，应考虑对在家居住且合并症较少的年轻患者进行筛查，无论其之前有无社区医疗接触或住院史。
