Černiauskienė Kristina, Vitkauskienė Astra
Department of Laboratory Medicine, Faculty of Medicine, Medical Academy, Lithuanian University of Health Science, Eivenių˛ Str. 2, LT-50161 Kaunas, Lithuania.
Trop Med Infect Dis. 2025 Jan 6;10(1):15. doi: 10.3390/tropicalmed10010015.
Due to resistance and the lack of treatment options, hospital-acquired () infections are associated with high mortality. This study aimed to analyze the characteristics of patients with infections caused by multidrug-resistant (MDR) and patients' clinical outcomes as well as determine the risk factors for mortality in a tertiary care teaching hospital.
A retrospective cohort study including 196 adult patients with strains isolated from different clinical specimens in the Hospital of the Lithuanian University of Health Sciences in 2016, 2017, 2020, and 2021 was conducted. Data on patients' characteristics, comorbid diseases, treatment, length of hospital and ICU stay, and outcome were collected. Carbapenemase-producing isolates were detected phenotypically. To determine risk factors for in-hospital mortality, logistic regression analysis was performed.
There were 60 (30.6%) women and 136 (69.4%) men with a mean age of 61.7 ± 16.6 years (range, 52-74). More than three-fourths (76.5%, = 150) of the patients had at least one comorbid disease. The highest number of strains were isolated from patients hospitalized in ICUs (43.4%, = 85). strains producing three types of -lactamases were more frequently isolated from women than men (77.8% vs. 22.2%, = 0.006). Infections caused by strains producing two types of -lactamases were significantly more often treated with combination therapy than infections caused by strains producing one type of -lactamase (78.9% vs. 60.0%, = 0.019). Patients with strains producing two different types of -lactamases (AmpC plus KPC, AmpC plus ESBL, or ESBL plus KPC) stayed significantly shorter at the ICU compared to patients with strains with no detected -lactamases (median of 9, IQR 2-18, vs. median of 26, IQR 7-38, = 0.022). Death occurred in 58.7% ( = 115) of patients. Logistic regression analysis showed that a duration of the effective antibiotic treatment of ≤6 days, invasive mechanical ventilation, combination therapy, aged >58 years, and the absence of co-infection were independent predictors of in-hospital mortality.
MDR infections pose a significant threat to human health not only due to multidrug resistance but also due to high mortality. The mortality rate of patients with MDR infection was high and was associated with age, invasive mechanical ventilation, the duration of effective antibiotic treatment, no co-infection, and combination therapy. Therefore, it is of utmost importance to reduce the prevalence of MDR infections in healthcare facilities by applying preventive measures and to administer timely effective treatment once infection is detected.
由于耐药性以及缺乏治疗选择，医院获得性（）感染与高死亡率相关。本研究旨在分析多重耐药（MDR）感染患者的特征、患者的临床结局，并确定一家三级护理教学医院中患者死亡的危险因素。
进行了一项回顾性队列研究，纳入了2016年、2017年、2020年和2021年在立陶宛卫生科学大学医院从不同临床标本中分离出菌株的196例成年患者。收集了患者特征、合并疾病、治疗、住院和重症监护病房（ICU）住院时间以及结局的数据。通过表型检测产碳青霉烯酶的分离株。为了确定院内死亡的危险因素，进行了逻辑回归分析。
共有60例（30.6%）女性和136例（69.4%）男性，平均年龄为61.7±16.6岁（范围52 - 74岁）。超过四分之三（76.5%，n = 150）的患者至少有一种合并疾病。从ICU住院患者中分离出的菌株数量最多（43.4%，n = 85）。产生三种β-内酰胺酶的菌株在女性中比男性更频繁地分离到（77.8%对22.2%，P = 0.006）。与产生一种β-内酰胺酶的菌株引起的感染相比，由产生两种β-内酰胺酶的菌株引起的感染显著更常采用联合治疗（78.9%对60.0%，P = 0.019）。与未检测到β-内酰胺酶的菌株患者相比，具有两种不同类型β-内酰胺酶（AmpC加KPC、AmpC加ESBL或ESBL加KPC）的菌株患者在ICU的住院时间显著更短（中位数为9天，四分位间距2 - 18天，对比中位数为26天，四分位间距7 - 38天，P = 0.022）。58.7%（n = 115）的患者死亡。逻辑回归分析表明，有效抗生素治疗持续时间≤6天、有创机械通气、联合治疗、年龄>58岁以及无合并感染是院内死亡的独立预测因素。
MDR感染不仅因其多重耐药性，还因其高死亡率对人类健康构成重大威胁。MDR感染患者的死亡率很高，且与年龄、有创机械通气、有效抗生素治疗持续时间、无合并感染以及联合治疗有关。因此，通过采取预防措施降低医疗机构中MDR感染的患病率，并在检测到感染后及时给予有效的治疗至关重要。
