Melinte Violeta, Radu Maria Adelina, Văcăroiu Maria Cristina, Mîrzan Luminița, Holban Tiberiu Sebastian, Ileanu Bogdan Vasile, Cismaru Ioana Miriana, Gheorghiță Valeriu
Department of Infectious Diseases, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
"Agrippa Ionescu" Clinical Emergency Hospital, 050474 Bucharest, Romania.
Antibiotics (Basel). 2025 Aug 1;14(8):783. doi: 10.3390/antibiotics14080783.
: Carbapenem-resistant (CRKP) represents a critical public health threat due to its rapid nosocomial dissemination, limited therapeutic options, and elevated mortality rates. This study aimed to characterize the epidemiology, carbapenemase profiles, and antimicrobial susceptibility patterns of CRKP isolates, as well as the clinical features and outcomes observed in infected or colonized patients. : We conducted a retrospective analysis of clinical and microbiological data from patients with CRKP infections or colonization admitted between January 2023 and January 2024. Descriptive statistics were used to assess prevalence, resistance patterns, and patient outcomes. Two binary logistic regression models were applied to identify independent predictors of sepsis and in-hospital mortality. : Among 89 CRKP isolates, 45 underwent carbapenemase typing. More than half were metallo-β-lactamase (MBL) producers, with 44.4% co-harbouring NDM and OXA-48-like enzymes. Surgical intervention was associated with a significantly lower risk of sepsis ( < 0.01) and in-hospital mortality ( = 0.045), whereas intensive care unit (ICU) stay was a strong predictor of both outcomes. ICU admission conferred a 10-fold higher risk of sepsis (95%Cl 2.4-41.0) and a 40.8-fold higher risk of in-hospital death (95% Cl 3.5-473.3). : This single-center retrospective study included a limited number of isolates in certain groups. Additionally, cefiderocol (FDC) susceptibility was assessed by disk diffusion rather than by the broth microdilution method. : Our study underscores the increasing prevalence of metallo-beta-lactamase-producing CRKP, particularly strains harbouring dual carbapenemases. Timely recognition of high-risk patients, combined with the implementation of targeted infection control measures and the integration of novel therapeutic options, is crucial to optimize clinical management and reduce mortality associated with CRKP.
耐碳青霉烯类肺炎克雷伯菌（CRKP）因其在医院内的快速传播、有限的治疗选择和较高的死亡率，对公共卫生构成了严重威胁。本研究旨在描述CRKP分离株的流行病学、碳青霉烯酶谱和抗菌药物敏感性模式，以及感染或定植患者的临床特征和结局。我们对2023年1月至2024年1月期间收治的CRKP感染或定植患者的临床和微生物学数据进行了回顾性分析。采用描述性统计方法评估患病率、耐药模式和患者结局。应用两个二元逻辑回归模型来确定脓毒症和院内死亡率的独立预测因素。在89株CRKP分离株中，45株进行了碳青霉烯酶分型。超过一半是金属β-内酰胺酶（MBL）产生菌，44.4%同时携带NDM和OXA-48样酶。手术干预与脓毒症风险显著降低（<0.01）和院内死亡率降低（=0.045）相关，而入住重症监护病房（ICU）是这两种结局的有力预测因素。入住ICU使脓毒症风险增加10倍（95%CI 2.4-41.0），院内死亡风险增加40.8倍（95%CI 3.5-473.3）。这项单中心回顾性研究在某些组中纳入的分离株数量有限。此外，头孢地尔（FDC）敏感性是通过纸片扩散法而非肉汤微量稀释法评估的。我们的研究强调了产金属β-内酰胺酶的CRKP的患病率不断上升，特别是携带双碳青霉烯酶的菌株。及时识别高危患者，结合实施有针对性的感染控制措施和整合新型治疗选择，对于优化临床管理和降低与CRKP相关的死亡率至关重要。
