Changing Epidemiology and Decreased Mortality Associated With Carbapenem-resistant Gram-negative Bacteria, 2000-2017
Changing Epidemiology and Decreased Mortality Associated With Carbapenem-resistant Gram-negative Bacteria, 2000-2017
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DOI：
10.1093/cid/ciaa1464
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发表时间：
2021-12-01
影响因子：
11.8
通讯作者：
Shields, Ryan K.
中科院分区：
文献类型：
--
作者：
Babiker, Ahmed;Clarke, Lloyd G.;Shields, Ryan K.
背景。碳青霉烯类耐药革兰氏阴性菌 (CRGNB) 继续造成全球医疗保健危机。我们的目的是确定近 2 年来 CRGNB 的新兴趋势，并描述 CRGNB 对患者结果的影响。方法。该研究纳入了 2000 年至 2017 年间分离出 CRGNB 的患者。碳青霉烯类耐药性由最近的断点定义并在整个研究期间应用。从电子健康记录中检索患者人口统计数据、临床特征和结果。结果。共鉴定出来自 64 422 名患者的 94 888 株分离株；来自 4038 名患者的 9882 株（10%）分离株具有碳青霉烯类耐药性。铜绿假单胞菌是每年最常见的 CRGNB。随着时间的推移，第二常见的 CRGNB 出现了一波又一波。碳青霉烯每日规定剂量与 CRGNB 率平行增加 (R-2 = 0.8131)。总体 30 天死亡率为 19%，从 2000 年的 24% 下降到 2017 年的 17%（P = 0.003；R-2 = 0.4330）。在 CRGNB 血流感染患者 (n = 319) 中，30 天和 90 天的总体死亡率分别为 27% 和 38%。 Charlson 评分（调整后比值比 [aOR]，1.11/点）、重症监护病房居住情况（aOR，7.32）和严重肝病（aOR，4.8.4）是 30 天死亡率的独立预测因素，而接受移植与较低的死亡率相关（aOR，0.39）。在 2011 年至 2017 年间收治的患者中（n = 2230），17% 在住院期间死亡，32% 被转移到长期护理机构，38% 出院回家。结论。 CRGNB 随着时间的推移一波又一波地出现，造成了很高的死亡率。尽管 CRGNB 的发病率不断增加，但患者的总体预后有所改善，这表明认识和新疗法已经产生了重大影响。
Background. Carbapenem-resistant gram-negative bacteria (CRGNB) continue to present a global healthcare crisis. We aimed to identify emerging trends of CRGNB over nearly 2 decades and describe the impact of CRGNB on patient outcomes.Methods. Patients from whom CRGNB were isolated between 2000 and 2017 were included in the study. Carbapenem resistance was defined by the most recent breakpoints and applied across the study period. Patient demographics, clinical characteristics, and outcomes were retrieved from the electronic health record.Results. A total of 94 888 isolates from 64 422 patients were identified; 9882 (10%) isolates from 4038 patients were carbapenemresistant. Pseudomonas aeruginosa was the most common CRGNB each year. The second most common CRGNB emerged in waves over time. Carbapenem daily defined doses increased in parallel with CRGNB rates (R-2 = 0.8131). The overall 30-day mortality rate was 19%, which decreased from 24% in 2000 to 17% in 2017 (P =.003; R-2 =.4330). Among patients with CRGNB bloodstream infections (n = 319), overall 30- and 90-day mortality rates were 27% and 38%, respectively. Charlson score (adjusted odds ratio [aOR], 1.11 per point), intensive care unit residence (aOR, 7.32), and severe liver disease (aOR, 4.8.4) were independent predictors of 30-day mortality, while receipt of transplantation was associated with lower rates of death (aOR, 0.39). Among patients admitted between 2011 and 2017 (n = 2230), 17% died during hospitalization, 32% were transferred to long-term care facilities, and 38% were discharged home.Conclusions. CRGNB emerged in waves over time, causing high rates of mortality. Despite increasing rates of CRGNB, overall patient outcomes have improved, suggesting that recognition and novel therapeutics have made a major impact.