Risk Factors for Carbapenem-Resistant Enterobacterales Clinical Treatment Failure.
Risk Factors for Carbapenem-Resistant Enterobacterales Clinical Treatment Failure.
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DOI：
10.1128/spectrum.02647-22
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发表时间：
2023-02-14
影响因子：
3.7
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中科院分区：
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疾病控制和预防中心（CDC）将碳青霉烯耐药肠杆菌（CRE）感染归类为“紧急”卫生保健威胁，需要公众关注和研究。某些CRE感染患者可能比其他患者有更高的临床预后不良的风险。为了确定CRE感染的高危人群，特别是使用可用于治疗CRE的新型β -内酰胺/ β -内酰胺酶抑制剂（BL/BLI）抗生素，有必要提供CRE感染的风险或保护因素的证据。我们的目的是确定CRE治疗中与临床失败相关的特定变量（30天死亡率，30天微生物复发，或在抗生素治疗过程中临床恶化/未能改善）。我们对2010年至2020年在密歇根州底特律的两个医疗系统取样的CRE感染住院患者进行了一项回顾性、观察性队列研究。如果患者年龄≥18岁，并且根据临床和实验室标准协会（CLSI）的断点对至少一种碳青霉烯类药物产生体外耐药性，导致临床感染的肠杆菌目的微生物培养呈阳性，则纳入患者。总的来说，有140例确诊的CRE感染，其中39%有临床失败。最常见的感染源是呼吸道（38%）、泌尿系统（20%）、腹腔内（16%）和原发性菌血症（14%）。建立了一个多变量logistic回归模型，以确定与临床衰竭有统计学意义的相关预测因素，包括顺序器官衰竭评估（SOFA）评分（调整比值比[aOR]为1.18；95%可信区间[CI]为1.06 ~ 1.32）、慢性透析（aOR, 5.86； 95% CI为1.51 ~ 22.7）和肺炎克雷伯菌指数培养（aOR, 3.09； 95% CI为1.28 ~ 7.47）。需要对CRE感染进行进一步研究，以确定促进治疗成功的最佳做法。这项研究比较了碳青霉烯耐药肠杆菌（CRE）感染的患者、临床和治疗变量，以了解哪些特征与临床失败的最高风险相关。了解与CRE感染失败相关的危险因素可以为临床医生提供更好的预后和有针对性的干预措施。研究还可以进一步调查为什么某些风险因素会导致更多的临床失败，并有助于制定治疗策略来减轻相关风险因素。
The Centers for Disease Control and Prevention (CDC) categorized carbapenem-resistant Enterobacterales (CRE) infections as an “urgent” health care threat requiring public attention and research. Certain patients with CRE infections may be at higher risk for poor clinical outcomes than others. Evidence on risk or protective factors for CRE infections are warranted in order to determine the most at-risk populations, especially with newer beta-lactam/beta-lactamase inhibitor (BL/BLI) antibiotics available to treat CRE. We aimed to identify specific variables involved in CRE treatment that are associated with clinical failure (either 30-day mortality, 30-day microbiologic recurrence, or clinical worsening/failure to improve throughout antibiotic treatment). We conducted a retrospective, observational cohort study of hospitalized patients with CRE infection sampled from 2010 to 2020 at two medical systems in Detroit, Michigan. Patients were included if they were ≥18 years old and culture positive for an organism in the Enterobacterales order causing clinical infection with in vitro resistance by Clinical and Laboratory Standards Institute (CLSI) breakpoints to at least one carbapenem. Overall, there were 140 confirmed CRE infections of which 39% had clinical failure. The most common infection sources were respiratory (38%), urinary (20%), intra-abdominal (16%), and primary bacteremia (14%). A multivariable logistic regression model was developed to identify statistically significant associated predictors with clinical failure, and they included Sequential Organ Failure Assessment (SOFA) score (adjusted odds ratio [aOR], 1.18; 95% confidence interval [CI], 1.06 to 1.32), chronic dialysis (aOR, 5.86; 95% CI, 1.51-22.7), and Klebsiella pneumoniae in index culture (aOR, 3.09; 95% CI, 1.28 to 7.47). Further research on CRE infections is needed to identify best practices to promote treatment success. IMPORTANCE This work compares carbapenem-resistant Enterobacterales (CRE) infections using patient, clinical, and treatment variables to understand which characteristics are associated with the highest risk of clinical failure. Knowing which risk factors are associated with CRE infection failure can provide clinicians better prognostic and targeted interventions. Research can also further investigate why certain risk factors cause more clinical failure and can help develop treatment strategies to mitigate associated risk factors.