Clinical characteristics and treatment outcomes of carbapenem-resistant Enterobacterales infections in Japan
Clinical characteristics and treatment outcomes of carbapenem-resistant Enterobacterales infections in Japan
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DOI：
10.1016/j.jgar.2022.04.004
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发表时间：
2022-05-06
影响因子：
4.6
通讯作者：
Yagi, Tetsuya
中科院分区：
文献类型：
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作者：
Oka, Keisuke;Matsumoto, Akane;Yagi, Tetsuya
目的：难治性碳青霉烯类耐药肠球菌（CRE）的传播是一个非常值得关注的问题。我们阐明了导致日本CRE感染死亡率的风险因素。方法：我们使用日本国家监测标准，对2014年9月至2016年12月28所大学医院的CRE感染患者进行了回顾性、多中心、观察性队列研究。收集临床信息，包括患者背景、感染类型、抗生素治疗和治疗结果。使用PCR测序确定碳青霉烯酶基因型。进行多因素分析，以确定28天死亡率的危险因素。结果如下：在入组的179例患者中，65例患者（36.3%）发生血流感染，其中37例（20.7%）感染由产碳青霉烯酶的肠球菌（CPE）引起;所有碳青霉烯酶均为IMP型（IMP-1：32，IMP-6：5）。三分之二的CPE被鉴定为阴沟肠杆菌复合菌。联合治疗46例（25.7%），28天死亡率为14.3%。单因素分析显示，实体转移癌、Charlson Comorbid指数>3、血流感染、肺炎或脓胸、中心静脉导管、机械通气和既往使用喹诺酮类药物是死亡率的重要危险因素。多因素分析显示机械通气（OR：6.71 [1.42-31.6]，P = 0.016），实体转移癌（OR：5.63 [1.38-23.0]，P = 0.016），血流感染（OR：3.49 [1.02-12.0]，P = 0.046）是28天死亡率的独立危险因素。日本CRE感染患者28天死亡率的重要风险因素是机械通气、实体转移癌，和血液感染。(c)2022作者（S）由Elsevier Ltd代表国际抗微生物化疗学会发表。这是一个开放获取的文章，在CC BY-NC-ND许可证下（http://creativecommons.org/licenses/by-nc-nd/4.0/）
Objectives: The dissemination of difficult-to-treat carbapenem-resistant Enterobacterales (CRE) is of great concern. We clarified the risk factors underlying CRE infection mortality in Japan.Methods: We conducted a retrospective, multicentre, observational cohort study of patients with CRE in-fections at 28 university hospitals from September 2014 to December 2016, using the Japanese National Surveillance criteria. Clinical information, including patient background, type of infection, antibiotic treat-ment, and treatment outcome, was collected. The carbapenemase genotype was determined using PCR sequencing. Multivariate analysis was performed to identify the risk factors for 28-day mortality. Results: Among the 179 patients enrolled, 65 patients (36.3%) had bloodstream infections, with 37 (20.7%) infections occurring due to carbapenemase-producing Enterobacterales (CPE); all carbapenemases were of IMP-type (IMP-1: 32, IMP-6: 5). Two-thirds of CPE were identified as Enterobacter cloacae complex. Com-bination therapy was administered only in 46 patients (25.7%), and the 28-day mortality rate was 14.3%. Univariate analysis showed that solid metastatic cancer, Charlson Comorbidity Index >3, blood-stream infection, pneumonia, or empyema, central venous catheters, mechanical ventilation, and prior use of quinolones were significant risk factors for mortality. Multivariate analysis revealed that mechani-cal ventilation (OR: 6.71 [1.42-31.6], P = 0.016), solid metastatic cancers (OR: 5.63 [1.38-23.0], P = 0.016), and bloodstream infections (OR: 3.49 [1.02-12.0], P = 0.046) were independent risk factors for 28-day mortality.Conclusion: The significant risk factors for 28-day mortality in patients with CRE infections in Japan are mechanical ventilation, solid metastatic cancers, and bloodstream infections.(c) 2022 The Author(s). Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )