Kong Haifang, Liu Yong, Yang Ling, Chen Qianqian, Li Yanchun, Hu Zhidong, Feng Xuequan, Chai Yamin, Dong Zuoliang
Department of Laboratory Medicine, Tianjin Medical University General Hospital, Tianjin, China.
Tianjin First Central Hospital of Nankai University, Tianjin, China.
Front Microbiol. 2025 Mar 19;16:1531984. doi: 10.3389/fmicb.2025.1531984. eCollection 2025.
Carbapenem-resistant bloodstream infection (CRKP-BSI) is a major public health threat worldwide. CRKP-BSI is associated with poor outcomes, elevated morbidity and mortality, and high healthcare costs. Therefore, the identification of risk factors for CRKP-BSI and mortality are critical for preventing and controlling CRKP in hospitals. This retrospective case-case-control study was conducted at General Hospital of Tianjin Medical University, a tertiary teaching hospital, from 2017 to 2023. It included 105 patients with CRKP-BSI (case group 1) and matched 105 patients with carbapenem-susceptible bloodstream infection (CSKP-BSI) (case group 2). The control group was selected at a ratio of 1:1:1 (case group 1: case group 2: control) from patients with a positive blood culture (except for infection) to analyze risk factors associated with the two case groups and compare the 30-day survival curves using multivariable logistic regression and Kaplan-Meier analyses. Multivariate analysis revealed that liver disease was a risk factor for -BSI, and exposure to carbapenem [odds ratio (OR) = 3.24], tigecycline (OR = 3.43), and glucocorticoids (OR = 4.64) were independent risk factors for CRKP-BSI. The 30-day mortality of the CRKP-BSI group was 30.5%, and patient groups, respiratory diseases (HR = 3.52), use of 3rd-generation cephalosporins (HR = 1.92), mechanical ventilation (HR = 2.14), and central venous catheter insertion (HR = 2.85) were independent risk factors, whereas a shorter length of hospitalization was a protective factor for 30-day mortality. The in-hospital mortality in the CRKP-BSI group was 55.2%, and arterial catheter use (OR = 3.76) was an independent risk factor for in-hospital mortality. Several factors were identified to contribute to the development of CRKP-BSI. CRKP isolates were resistant to most antibiotics. Reducing CRKP-BSI-related mortality requires comprehensive consideration of underlying diseases, judicious antibiotic use, and invasive procedures. The high morbidity, mortality, along with the limited therapeutic options for CRKP-BSI, underscore the need for improved detection, identification of risk factors to develop effective preventive measures, and development of novel agents with reliable clinical efficacy against CRKP.
耐碳青霉烯类血流感染（CRKP-BSI）是全球主要的公共卫生威胁。CRKP-BSI与不良预后、发病率和死亡率升高以及高昂的医疗费用相关。因此，识别CRKP-BSI和死亡率的危险因素对于医院预防和控制CRKP至关重要。这项回顾性病例-病例对照研究于2017年至2023年在天津医科大学总医院（一家三级教学医院）进行。研究纳入了105例CRKP-BSI患者（病例组1），并匹配了105例碳青霉烯类敏感血流感染（CSKP-BSI）患者（病例组2）。对照组从血培养阳性患者（不包括感染患者）中按1:1:1的比例选取（病例组1:病例组2:对照组），以分析与两个病例组相关的危险因素，并使用多变量逻辑回归和Kaplan-Meier分析比较30天生存曲线。多变量分析显示，肝病是BSI的危险因素，而使用碳青霉烯类药物[比值比（OR）=3.24]、替加环素（OR = 3.43）和糖皮质激素（OR = 4.64）是CRKP-BSI的独立危险因素。CRKP-BSI组的30天死亡率为30.5%，患者群体、呼吸系统疾病（HR = 3.52）、使用第三代头孢菌素（HR = 1.92）、机械通气（HR = 2.14）和中心静脉导管插入（HR = 2.85）是独立危险因素，而住院时间较短是30天死亡率的保护因素。CRKP-BSI组的院内死亡率为55.2%，使用动脉导管（OR = 3.76）是院内死亡率的独立危险因素。确定了几个导致CRKP-BSI发生的因素。CRKP分离株对大多数抗生素耐药。降低CRKP-BSI相关死亡率需要综合考虑基础疾病、合理使用抗生素和侵入性操作。CRKP-BSI的高发病率、死亡率以及有限的治疗选择凸显了改进检测、识别危险因素以制定有效预防措施以及开发对CRKP具有可靠临床疗效的新型药物的必要性。
