Department of Laboratory Medicine, Tianjin Medical University General Hospital, Tianjin, China.
Tianjin Medical University General Hospital, Tianjin, China.
Microbiol Spectr. 2024 Jul 2;12(7):e0422823. doi: 10.1128/spectrum.04228-23. Epub 2024 May 30.
The emergence of carbapenem-resistant strains poses a considerable challenge to global public health, and little is known about carbapenemase-producing strains in Tianjin, China. This study aimed to investigate the risk factors for infections with carbapenem-resistant (CREC) strains. This retrospective case-control study was conducted at a tertiary teaching hospital. A total of 134 CREC clinical isolates were collected from the General Hospital of Tianjin Medical University between 2013 and 2020. The control group was selected at a ratio of 1:1 from patients with nosocomial carbapenem-susceptible infection. Risk factors for nosocomial CREC infection and clinical outcomes were analyzed using univariate and multivariate analyses. Multivariate analysis revealed that cephalosporin exposure (odd ratio OR = 2.01), carbapenem exposure (OR = 1.96), glucocorticoid exposure (OR = 32.45), and surgical history (OR = 3.26) were independent risk factors for CREC infection. The in-hospital mortality rate in the CREC group was 29.1%, and age >65 years (OR = 3.19), carbapenem exposure (OR = 3.54), and central venous catheter insertion (OR = 4.19) were independent risk factors for in-hospital mortality in patients with CREC infections. Several factors were identified in the development of nosocomial CREC infections. The CREC isolates were resistant to most antibiotics. Reducing CREC mortality requires a comprehensive consideration of appropriate antibiotic use, underlying diseases, and invasive procedures.IMPORTANCE is an opportunistic pathogen that causes severe hospital-acquired infections. The spread of carbapenem-resistant is a global threat to public health, and only a few antibiotics are effective against these infections. Consequently, these infections are usually associated with poor prognosis and high mortality. Therefore, understanding the risk factors associated with the causes and outcomes of these infections is crucial to reduce their incidence and initiate appropriate therapies. In our study, several factors were found to be involved in nosocomial carbapenem-resistant (CREC) infections, and CREC isolates were resistant to most antibiotics. Reducing CREC mortality needs a comprehensive consideration of whether antibiotics are used appropriately, underlying diseases, and invasive interventions. These findings provide valuable evidence for the development of anti-infective therapy, infection prevention, and control of CREC-positive infections.
碳青霉烯类耐药 （CREC） 菌株的出现对全球公共卫生构成了相当大的挑战，而中国天津产碳青霉烯酶 （CRE） 菌株的情况知之甚少。本研究旨在探讨耐碳青霉烯类 （CRE） 感染的危险因素。这项回顾性病例对照研究在一家三级教学医院进行。共从 2013 年至 2020 年期间从天津医科大学总医院收集了 134 株 CREC 临床分离株。对照组是从医院获得性碳青霉烯类敏感 （CREC） 感染患者中以 1:1 的比例选择的。使用单因素和多因素分析分析了医院获得性 CREC 感染和临床结果的危险因素。多因素分析显示，头孢菌素暴露（比值比 [OR] = 2.01）、碳青霉烯类暴露（OR = 1.96）、糖皮质激素暴露（OR = 32.45）和手术史（OR = 3.26）是 CREC 感染的独立危险因素。CREC 组的院内死亡率为 29.1%，年龄>65 岁（OR = 3.19）、碳青霉烯类暴露（OR = 3.54）和中心静脉导管插入（OR = 4.19）是 CREC 感染患者院内死亡的独立危险因素。在医院获得性 CREC 感染的发生中确定了几个因素。CREC 分离株对大多数抗生素具有耐药性。降低 CREC 死亡率需要综合考虑适当使用抗生素、基础疾病和侵入性操作。
重要的是一种机会性病原体，可引起严重的医院获得性感染。碳青霉烯类耐药 （CRE） 的传播对全球公共卫生构成威胁，只有少数抗生素对这些感染有效。因此，这些感染通常与不良预后和高死亡率相关。因此，了解导致这些感染的原因和结果的危险因素对于降低其发病率和启动适当的治疗至关重要。在我们的研究中，发现了几个因素与医院获得性碳青霉烯类耐药 （CREC） 感染有关，并且 CREC 分离株对大多数抗生素具有耐药性。降低 CREC 死亡率需要综合考虑是否适当使用抗生素、基础疾病和侵入性干预。这些发现为制定抗感染治疗、感染预防和控制 CREC 阳性感染的策略提供了有价值的证据。
