Deng Sheng, Chen Jinglan, Zhou Pengxiang, Hu Qin
Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
BMC Infect Dis. 2025 Jan 23;25(1):110. doi: 10.1186/s12879-025-10454-z.
To determine the mortality-related risk factors for carbapenem-resistant Enterobacteriaceae (CRE) infection in hospitalized patients and to compare the clinical efficacy of different antimicrobial regimen.
Data were retrospectively collected from a 3,500-bed regional medical center between January 2021 and June 2022. Mortality-related risk factors were analyzed by the Cox proportional regression model for multivariate analysis.
120 patients were included and the all-cause mortality was 20.8% (25/120). Multivariate analysis showed that age (HR = 1.035, 95%CI: 1.002-1.070, P = 0.036), SOFA score (HR = 1.169,95%CI: 1.066-1.281, P = 0.001), central venous catheter (HR = 3.858, 95%CI: 1.411-10.547, P = 0.009), the length of hospital stay (HR = 0.868, 95% CI: 0.806-0.936, P = 0.000) and combination therapy (HR = 3.152, 95%CI: 1.205-8.245, P = 0.019) were independent mortality risk factors after CRE infection. All patients received definitive therapy and 65.0% (78/120) received sensitive drug treatment. Among those 65.4% (51/78) received combination therapy and 34.6% (27/78) received monotherapy. Subgroup analysis of the non-sepsis group showed significantly lower mortality in monotherapy than in combination therapy (0% versus 22.2%, P = 0.034). Patients who received carbapenem-containing therapy had significantly higher mortality than those who received carbapenem-sparing therapy (31.3% versus 13.9%, P = 0.022). CAZ-AVI-containing therapy presented a lower mortality (19.0%) and a higher 7-day microbiological clearance (47.6%) compared to other antimicrobial regimens, but there were no statistical significance (P>0.05).
Patients with older age, higher SOFA score, central venous catheter, shorter hospital stay after CRE infection may had poor outcomes. Since patients with non-sepsis have a lower mortality rate from monotherapy, combination antibiotic treatment should not be routinely recommended. Patients who received CAZ-AVI-containing therapy presented a lower mortality compared to other antimicrobial regimens without statistical significance, further larger sample size is needed for verification.
确定住院患者耐碳青霉烯类肠杆菌科细菌（CRE）感染的死亡相关危险因素，并比较不同抗菌方案的临床疗效。
回顾性收集2021年1月至2022年6月间一家拥有3500张床位的区域医疗中心的数据。采用Cox比例回归模型进行多因素分析，分析死亡相关危险因素。
共纳入120例患者，全因死亡率为20.8%（25/120）。多因素分析显示，年龄（HR = 1.035，95%CI：1.002 - 1.070，P = 0.036）、序贯器官衰竭评估（SOFA）评分（HR = 1.169，95%CI：1.066 - 1.281，P = 0.001）、中心静脉导管（HR = 3.858，95%CI：1.411 - 10.547，P = 0.009）、住院时间（HR = 0.868，95%CI：0.806 - 0.936，P = 0.000）和联合治疗（HR = 3.152，95%CI：1.205 - 8.245，P = 0.019）是CRE感染后独立的死亡危险因素。所有患者均接受了确定性治疗，65.0%（78/120）接受了敏感药物治疗。其中65.4%（51/78）接受联合治疗，34.6%（27/78）接受单药治疗。非脓毒症组的亚组分析显示，单药治疗的死亡率显著低于联合治疗（0%对22.2%，P = 0.034）。接受含碳青霉烯类治疗的患者死亡率显著高于接受碳青霉烯类保留治疗的患者（31.3%对13.9%，P = 0.022）。与其他抗菌方案相比，含头孢他啶 - 阿维巴坦（CAZ - AVI）的治疗死亡率较低（19.0%），7天微生物清除率较高（47.6%），但差异无统计学意义（P>0.05）。
年龄较大、SOFA评分较高、有中心静脉导管、CRE感染后住院时间较短的患者预后可能较差。由于非脓毒症患者单药治疗的死亡率较低，不应常规推荐联合抗生素治疗。与其他抗菌方案相比，接受含CAZ - AVI治疗的患者死亡率较低，但差异无统计学意义，需要进一步更大样本量进行验证。
