Zhang Yufei, Zou Chengyun, Qin Jie, Li Muyi, Wang Xing, Wei Tian, Wang Haiying
Department of Clinical Laboratory Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China.
Department of Clinical Laboratory Shanghai Fifth People's Hospital Fudan University, Shanghai 200240, China.
Can J Infect Dis Med Microbiol. 2024 Aug 28;2024:5459549. doi: 10.1155/2024/5459549. eCollection 2024.
Elderly patients with carbapenem-resistant (CRE) infections represent considerable mortality rates. But data on the risk factors for the death of elderly patients following such infection remain limited. We aimed to assess the clinical outcomes, identify mortality-associated risk factors, and determine the antibiotic resistance and resistance genes of isolates for these patients. Hospitalized patients aged ≥65 years with CRE infection from January 2020 to December 2020 were retrospectively reviewed. Isolates identification and molecular characterization of CRE were carried out. Logistic regression analysis was applied to assess the potential factors associated with mortality. Of the 123 elderly patients with CRE infection included in our study, the all-cause mortality rate was 39.8% (49/123). The most prevalent pathogen was carbapenem-resistant (CRKP, 116 of 123). The overall rates of multidrug-resistant (MDR) and extensively drug-resistant (XDR) were 100.0% and 66.7%. All CRE isolates exclusively harbored a singular variant of carbapenemase gene, such as , , , or , while 98.4% of isolates harbored more than one -lactamase gene, of which 106 (86.2%) isolates harbored , 121 (98.4%) isolates harbored , and 116 (94.3%) isolates harbored . Multivariable logistic regression analysis revealed that mechanical ventilation (adjusted odds ratio (AOR) = 33.607, 95% confidence interval (CI): 4.176-270.463, < 0.001), use of tigecycline during hospitalization (AOR = 5.868, 95% CI: 1.318-26.130, = 0.020), and APACHE II score (AOR = 1.305, 95% CI: 1.161-1.468, < 0.001) were independent factors associated with increasing the mortality of patients with CRE infection, while admission to intensive care unit (ICU) during hospitalization (AOR = 0.046, 95% CI: 0.004-0.496, = 0.011) was a protective factor. CRE-infected elderly patients with mechanical ventilation, use of tigecycline during hospitalization, and high APACHE II score were related to poor outcomes. The isolates carried various antibiotic genes and presented high antibiotic resistance. These findings provide crucial guidance for clinicians to devise appropriate strategies for treatment.
耐碳青霉烯类肠杆菌科细菌（CRE）感染的老年患者死亡率相当高。但关于此类感染后老年患者死亡的危险因素的数据仍然有限。我们旨在评估临床结局，确定与死亡相关的危险因素，并确定这些患者分离株的抗生素耐药性和耐药基因。对2020年1月至2020年12月期间年龄≥65岁的CRE感染住院患者进行回顾性研究。进行了CRE的分离株鉴定和分子特征分析。应用逻辑回归分析评估与死亡率相关的潜在因素。在我们纳入研究的123例CRE感染老年患者中，全因死亡率为39.8%（49/123）。最常见的病原体是耐碳青霉烯类肺炎克雷伯菌（CRKP，123例中的116例）。多重耐药（MDR）和广泛耐药（XDR）的总体发生率分别为100.0%和66.7%。所有CRE分离株均仅携带一种碳青霉烯酶基因变体，如 、 、 或 ，而98.4%的分离株携带不止一种β-内酰胺酶基因，其中106株（86.2%）携带 ，121株（98.4%）携带 ，116株（94.3%）携带 。多变量逻辑回归分析显示，机械通气（调整优势比（AOR）=33.607，95%置信区间（CI）：4.176-270.463，P<0.001）、住院期间使用替加环素（AOR=5.868，95%CI：1.318-26.130，P=0.020）和急性生理与慢性健康状况评分系统II（APACHE II）评分（AOR=1.305，95%CI：1.161-1.468，P<0.001）是与CRE感染患者死亡率增加相关的独立因素，而住院期间入住重症监护病房（ICU）（AOR=0.046，95%CI：0.004-0.496，P=0.011）是一个保护因素。接受机械通气、住院期间使用替加环素且APACHE II评分高的CRE感染老年患者预后较差。分离株携带多种抗生素基因并呈现出高耐药性。这些发现为临床医生制定适当的治疗策略提供了关键指导。
