Department of Infection Control Center, Xiangya Hospital, Central South University, Changsha, Hunan Province, China.
Super drug-resistant Organism Infection Prevention and Control Research Center, Xiangya Hospital, Changsha, Hunan Province, China.
Sci Rep. 2024 Oct 29;14(1):26017. doi: 10.1038/s41598-024-76261-9.
It is generally believed that Carbapenem-resistant Enterobacterales (CRE) colonization is primarily responsible for systemic infection in humans. However, there is no consensus on whether decolonization should be recommended in clinical practice. In China, the specific situation of CRE colonization and consequent systemic infection in hospitalized patients necessitates further exploration. We conducted a cohort study and analyzed various clinical characteristics of inpatients with intestinal CRE colonization. A risk prediction model for consequent CRE infection was established and externally validated. Our prediction model is freely available online at https://creinfection.shinyapps.io/dynnomapp/ . 839 intestinal CRE colonization samples from inpatients were included. 317 cases of intestinal CRE colonization were enrolled, 25.9% of whom developed systemic infections. The consequent CRE infection rates of Klebsiella pneumoniae and Escherichia coli were 27.0% and 32.3%. The departments at high risk for subsequent CRE infection were respiratory medicine, hematology, and intensive care unit. Secondary infection after intestinal CRE colonization in inpatients can significantly prolong the length of hospital stay (26 days vs. 33 days, P < 0.001), increase the total medical cost (144735.34￥ vs. 281852.34￥, P < 0.001), and has poor (85.11% vs. 52.44%, P < 0.001) efficacy and high mortality (5.96% vs. 18.29%, P = 0.001). Our study makes a significant contribution to comprehensively specify CRE infection, because these results can facilitate early identification of high-risk hospitalized patients, timely implementation to decolonize treatment interventions, ultimately achieve the goal of CRE nosocomial infection prevention and control.
人们普遍认为，耐碳青霉烯肠杆菌科（CRE）定植是导致人类全身感染的主要原因。然而，关于是否应在临床实践中推荐去定植，目前尚无共识。在中国，住院患者 CRE 定植和随之发生的全身感染的具体情况需要进一步探索。我们进行了一项队列研究，分析了住院患者肠道 CRE 定植的各种临床特征。建立并外部验证了 CRE 感染的风险预测模型。我们的预测模型可在 https://creinfection.shinyapps.io/dynnomapp/ 免费在线获取。该研究纳入了 839 例住院患者的肠道 CRE 定植样本。317 例肠道 CRE 定植患者中，有 25.9%发生了全身感染。肺炎克雷伯菌和大肠埃希菌的继发 CRE 感染率分别为 27.0%和 32.3%。发生继发 CRE 感染的高危科室为呼吸内科、血液科和重症监护病房。住院患者肠道 CRE 定植后的继发感染可显著延长住院时间（26 天比 33 天，P<0.001），增加总医疗费用（144735.34 元比 281852.34 元，P<0.001），且疗效差（85.11%比 52.44%，P<0.001）、死亡率高（5.96%比 18.29%，P=0.001）。我们的研究对全面阐明 CRE 感染有重要贡献，因为这些结果可以帮助早期识别高危住院患者，及时实施去定植治疗干预，最终实现 CRE 医院感染防控的目标。
