title: Risk factors and clinical outcomes for carbapenem-resistant Enterobacteriaceae nosocomial infections.
abstract: This study was aimed to determine the risk factors of Carbapenem-resistant Enterobacteriaceae (CRE) nosocomial infections and assess the clinical outcomes. A case-case-control design was used to compare two groups of case patients with control patients from March 2010 to November 2014 in China. Risk factors for the acquisition of CRE infections and clinical outcomes were analyzed by univariable and multivariable analysis. A total of 94 patients with CRE infections, 93 patients with Carbapenem-susceptible Enterobacteriaceae (CSE) infections, and 93 patients with organisms other than Enterobacteriaceae infections were enrolled in this study. Fifty-five isolates were detected as the carbapenemase gene. KPC-2 was the most common carbapenemase (65.5 %, 36/55), followed by NDM-1 (16.4 %, 9/55), IMP-4 (14.5 %, 8/55), NDM-5 (1.8 %, 1/55), and NDM-7 (1.8 %, 1/55). Multivariable analysis implicated previous use of third or fourth generation cephalosporins (odds ratio [OR], 4.557; 95 % confidence interval [CI], 1.971-10.539; P < 0.001) and carbapenems (OR, 4.058; 95 % CI, 1.753-9.397; P = 0.001) as independent risk factors associated with CRE infection. The in-hospital mortality of the CRE group was 57.4 %. In the population of CRE infection, presence of central venous catheters (OR, 4.464; 95 % CI, 1.332-14.925; P = 0.015) and receipt of immunosuppressors (OR, 7.246; 95 % CI, 1.217-43.478; P = 0.030) were independent risk factors for mortality. Appropriate definitive treatment (OR, 0.339; 95 % CI, 0.120-0.954; P = 0.040) was a protective factor for in-hospital death of CRE infection. Kaplan-Meier curves of the CRE group had the shortest survival time compared with the other two groups. Survival time of patients infected with Enterobacteriaceae with a high meropenem MIC (≥8 mg/L) was shorter than that of patients with a low meropenem MIC (2,4, and ≤ 1 mg/L). In conclusion, CRE nosocomial infections are associated with prior exposure to third or fourth generation cephalosporins and carbapenems. Patients infected with CRE had poor outcome and high mortality, especially high meropenem MIC (≥8 mg/L). Appropriate definitive treatment to CRE infections in the patient is essential.
authors.affiliation: Department of Clinical Laboratory, Peking University People's Hospital, Beijing, 100044, China.
authors.forename: Q
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of Clinical Laboratory, Peking University People's Hospital, Beijing, 100044, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital of Capital Medical University, Beijing, 150060, China.
authors.forename: X
authors.initials: X
authors.lastname: Yao
authors.affiliation: Department of Clinical Laboratory, Peking University People's Hospital, Beijing, 100044, China.
authors.forename: H
authors.initials: H
authors.lastname: Xian
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital of Capital Medical University, Beijing, 150060, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital of Capital Medical University, Beijing, 150060, China.
authors.forename: H
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Clinical Laboratory, Peking University People's Hospital, Beijing, 100044, China.
authors.forename: H
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Clinical Laboratory, Peking University People's Hospital, Beijing, 100044, China.
authors.forename: X
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Clinical Laboratory, Peking University People's Hospital, Beijing, 100044, China.
authors.forename: R
authors.initials: R
authors.lastname: Wang
authors.affiliation: Department of Clinical Laboratory, Peking University People's Hospital, Beijing, 100044, China.
authors.forename: C
authors.initials: C
authors.lastname: Zhao
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital of Capital Medical University, Beijing, 150060, China.
authors.forename: B
authors.initials: B
authors.lastname: Cao
authors.affiliation: Department of Clinical Laboratory, Peking University People's Hospital, Beijing, 100044, China. wanghui@pkuph.edu.cn.
authors.forename: H
authors.initials: H
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000235:genetics; D015780:Carbapenems / Q000494:pharmacology*; D016022:Case-Control Studies; D002681:China / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D001618:beta-Lactamases; C063912:carbapenemase