Kim Myongjin, Jeon Kibum, Kym Dohern, Jung Jinsun, Jang Yu Jin, Han Seung Beom
Department of Surgery and Critical care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea.
Infection Control and Prevention Unit, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea.
Antimicrob Resist Infect Control. 2025 Jan 29;14(1):3. doi: 10.1186/s13756-025-01514-9.
Clinical characteristics and outcomes of carbapenem-resistant Enterobacterales (CRE) infection and colonization have rarely been reported in patients with severe burns, who are prone to severe bacterial infections. This study aimed to evaluate clinical characteristics and outcomes of CRE infection and colonization in patients with severe burns.
The characteristics of 106 episodes of CRE acquisition (infection or colonization) in 98 patients with severe burns were evaluated by a retrospective medical record review. The duration of rectal CRE colonization and its associated factors were determined in the survived patients.
Five (4.7%) of the CRE acquisitions were identified on admission, and the remaining 101 (95.3%) were identified at a median of 11 days (range 2-75 days) after admission. Klebsiella pneumoniae represented 73.6% of the isolated CRE strains, and carbapenemase-producing CRE (CP-CRE) were identified in 70.8% of the isolates. Mortality was associated with an abbreviated burn severity index (ABSI) score ≥ 10 (p < 0.001) and previous carbapenem-resistant bacterial acquisition (protective, p = 0.010). For the 58 episodes of CRE acquisition in the survived patients, eradication of rectal CRE colonization was identified in 39 (67.2%) at a median of 64 days (range 10-434 days) after acquisition. CP-CRE strains were associated with prolonged rectal CRE colonization (p < 0.001).
The characteristics of CRE infection and colonization in patients with severe burns were similar to those in general critical patients. Enhanced infection prevention and control measures should be considered for patients with severe burns of an ABSI score ≥ 10 and those with CP-CRE.
耐碳青霉烯类肠杆菌科细菌（CRE）感染和定植的临床特征及结局在严重烧伤患者中鲜有报道，而严重烧伤患者易发生严重细菌感染。本研究旨在评估严重烧伤患者中CRE感染和定植的临床特征及结局。
通过回顾性病历审查评估98例严重烧伤患者106次CRE获得（感染或定植）事件的特征。在存活患者中确定直肠CRE定植的持续时间及其相关因素。
5例（4.7%）CRE获得事件在入院时被识别，其余101例（95.3%）在入院后中位11天（范围2 - 75天）被识别。肺炎克雷伯菌占分离出的CRE菌株的73.6%，70.8%的分离株为产碳青霉烯酶CRE（CP-CRE）。死亡率与简化烧伤严重程度指数（ABSI）评分≥10（p < 0.001）及既往获得耐碳青霉烯类细菌（有保护作用，p = 0.010）相关。对于存活患者中的58次CRE获得事件，39例（67.2%）在获得后中位64天（范围10 - 434天）直肠CRE定植被清除。CP-CRE菌株与直肠CRE定植时间延长相关（p < 0.001）。
严重烧伤患者中CRE感染和定植的特征与一般危重症患者相似。对于ABSI评分≥10的严重烧伤患者及CP-CRE患者，应考虑加强感染预防和控制措施。
