Song Xixi, Xu Chonghe, Zhu Zhongqi, Zhang Chenchen, Qin Chao, Liu Juan, Kong Xiaoli, Zhu Zhijun, Xu Wei, Zhu Mei
Department of Clinical Laboratory, The Affiliated Chaohu Hospital of Anhui Medical University, ChaoHu, Anhui, China.
Beijing Friendship Hospital, Capital Medical University, Beijing, China.
mSystems. 2025 Jul 10:e0175724. doi: 10.1128/msystems.01757-24.
The prevalence of multidrug-resistant (MDR-KP) is rising globally. The aim of this study was to investigate the epidemiology, risk factors, and clinical outcomes of MDR-KP coinfections with multiple microbes and infections with carbapenem-resistant (CRKP) among patients in a tertiary hospital in China and to establish an individualized linear prediction model. In this retrospective study, patients admitted from January 2021 to March 2024 with a diagnosis of MDR-KP infection were included. We recorded demographics, comorbidities, laboratory indicators, therapeutic interventions, antimicrobial susceptibility tests (ASTs), and analyzed clinical outcomes. Logistic regression models were employed to evaluate the risk factors associated with MDR-KP coinfections and infections with CRKP. A total of 164 patients with MDR-KP infection were included. Of these patients, 78 (47.6%) were infected with MDR-KP only, and 86 (52.4%) were coinfected with other microbes; 115 (70.1%) were infected with extended-spectrum beta-lactamase-producing (ESBL-KP), and 49 (29.9%) were infected with CRKP. The most common source of infection among patients with MDR-KP infection was the respiratory tract (96/164, 58.5%), followed by the urinary tract (31/164, 18.9%). Multivariate logistic regression analysis showed that nasogastric catheters (odds ratio [OR], 5.351; 95% confidence inteval [CI], 1.437-19.926, = 0.012), as well as venous and arterial catheters (OR, 5.182; 95% CI, 1.272-21.113, = 0.022), were independent risk factors for coinfection. The total risk score for all factors was 143.3, with a predicted risk rate ranging from 0.25 to 0.85. In the receiver operating characteristic (ROC) analysis, the area under the curve (AUC) for predicting coinfection based on the total risk score was 0.773 (95% CI: 0.7054-0.8405). Tracheostomy (OR, 4.673; 95% CI, 1.153-18.937, = 0.031) and fiberoptic bronchoscopy (OR, 4.041; 95% CI, 1.305-12.516, = 0.015) were independent risk factors for infection with CRKP. The total risk score for all factors was 193.9, with a predicted risk rate ranging from 0.15 to 0.85. In the ROC analysis, the AUC for predicting CRKP using the total risk score was 0.752 (95% CI: 0.6739-0.8306). Analysis of the calibration curve indicated good agreement between the observed and predicted values. The log-rank test was used to compare all-cause mortality between the two groups, and 30-day mortality was higher in the coinfected group than that in the MDR-KP alone group ( = 0.03). There was no significant difference in 30-day mortality between the CRKP and ESBL-KP groups ( = 0.09). This study successfully established a predictive model based on risk factors, which has good predictive value for both patients with coinfections and those with CRKP. Coinfections and CRKP infections were significantly associated with increased overall mortality, elevated healthcare costs, and poor prognosis in patients. These findings provided a basis for further clinical research and optimization of management strategies for MDR-KP coinfections and CRKP infections.
Coinfections and carbapenem-resistant (CRKP) infections significantly increased morbidity and economic burden, leading to longer intensive care unit (ICU) stays and poorer prognoses. Coinfection may also lead to a higher 30-day mortality rate. Patients suffering from multidrug-resistant (MDR-KP) used two or more antibiotics for infection control, but the therapeutic outcomes remained suboptimal. In order to reverse the rising trend in mortality rate associated with coinfection and CRKP infection, certain measures need to be taken: (i) develop stricter protocols for terminal cleaning of rooms (especially ICUs), cleaning of equipment (such as bronchoscopes) and hand hygiene; (ii) conduct antimicrobial resistance gene testing in the healthcare environment and implement antimicrobial stewardship to optimize antibiotic consumption and reduce the emergence and spread of multidrug-resistant organisms.
耐多药肺炎克雷伯菌（MDR-KP）的全球流行率正在上升。本研究旨在调查中国一家三级医院患者中MDR-KP与多种微生物合并感染以及耐碳青霉烯类肺炎克雷伯菌（CRKP）感染的流行病学、危险因素和临床结局，并建立个体化线性预测模型。在这项回顾性研究中，纳入了2021年1月至2024年3月期间诊断为MDR-KP感染的住院患者。我们记录了人口统计学、合并症、实验室指标、治疗干预、抗菌药物敏感性试验（ASTs），并分析了临床结局。采用逻辑回归模型评估与MDR-KP合并感染和CRKP感染相关的危险因素。共纳入164例MDR-KP感染患者。其中，78例（47.6%）仅感染MDR-KP，86例（52.4%）与其他微生物合并感染；115例（70.1%）感染产超广谱β-内酰胺酶肺炎克雷伯菌（ESBL-KP），49例（29.9%）感染CRKP。MDR-KP感染患者中最常见的感染源是呼吸道（96/164，58.5%），其次是泌尿道（31/164，18.9%）。多因素逻辑回归分析显示，鼻胃管（比值比[OR]，5.351；95%置信区间[CI]，1.437 - 19.926，P = 0.012）以及动静脉导管（OR，5.182；95%CI，1.272 - 21.113，P = 0.022）是合并感染的独立危险因素。所有因素的总风险评分为143.3，预测风险率范围为0.25至0.85。在受试者工作特征（ROC）分析中，基于总风险评分预测合并感染的曲线下面积（AUC）为0.773（95%CI：0.7054 - 0.8405）。气管切开术（OR，4.673；95%CI，1.153 - 18.937，P = 0.031）和纤维支气管镜检查（OR，4.041；95%CI，1.305 - 12.516，P = 0.015）是CRKP感染的独立危险因素。所有因素的总风险评分为193.9，预测风险率范围为0.15至0.85。在ROC分析中，使用总风险评分预测CRKP的AUC为0.752（95%CI：0.6739 - 0.8306）。校准曲线分析表明观察值与预测值之间具有良好的一致性。采用对数秩检验比较两组患者全因死亡率，合并感染组30天死亡率高于单纯MDR-KP组（P = 0.03）。CRKP组与ESBL-KP组30天死亡率无显著差异（P = 0.09）。本研究成功建立了基于危险因素的预测模型，对合并感染患者和CRKP感染患者均具有良好的预测价值。合并感染和CRKP感染与患者总体死亡率增加、医疗费用升高及预后不良显著相关。这些发现为进一步的临床研究以及优化MDR-KP合并感染和CRKP感染的管理策略提供了依据。
合并感染和耐碳青霉烯类肺炎克雷伯菌（CRKP）感染显著增加了发病率和经济负担，导致重症监护病房（ICU）住院时间延长和预后更差。合并感染还可能导致30天死亡率更高。耐多药肺炎克雷伯菌（MDR-KP）患者使用两种或更多种抗生素来控制感染，但治疗效果仍不理想。为了扭转与合并感染和CRKP感染相关的死亡率上升趋势，需要采取某些措施：（i）制定更严格的病房（尤其是ICU）终末清洁、设备（如支气管镜）清洁和手卫生规程；（ii）在医疗环境中进行抗菌药物耐药基因检测并实施抗菌药物管理，以优化抗生素使用并减少多重耐药菌的出现和传播。
