A prospective study of treatment of carbapenem-resistant Enterobacteriaceae infections and risk factors associated with outcome.
BACKGROUND
To describe the clinical and microbiological data of carbapenem-resistant Enterobacteriaceae (CRE) infections, the treatment used, hospital- and infection-related mortality, and risk factors for death.


METHODS
A prospective cohort conducted from March 2011 to December 2012. Clinical, demographic, and microbiological data such as in vitro sensitivity, clonality, carbapenemase gene mortality related to infection, and overall mortality were evaluated. Data were analyzed using Epi Info version 7.0 (CDC, Atlanta, GA, USA) and SPSS (Chicago, IL, USA).


RESULTS
One hundred and twenty-seven patients were evaluated. Pneumonia, 52 (42 %), and urinary tract infections (UTI), 51 (40.2 %), were the most frequent sites of infection. The isolates were polyclonal; the BlaKPCgene was found in 75.6 % of isolates, and 27 % of isolates were resistant to colistin. Mortality related to infection was 34.6 %, and was higher among patients with pneumonia (61.4 %). Combination therapy was used in 98 (77.2 %), and monotherapy in 22.8 %; 96.5 % of them were UTI patients. Shock, age, and dialysis were independent risk factors for death. There was no difference in infection-related death comparing colistin-susceptible and colistin-resistant infections (p = 0.46); neither in survival rate comparing the use of combination therapy with two drugs or more than two drugs (p = 0.32).


CONCLUSIONS
CRE infection mortality was higher among patients with pneumonia. Infections caused by colistin-resistant isolates did not increase mortality. The use of more than two drugs on combination therapy did not show a protective effect on outcome. The isolates were polyclonal, and the blaKPCgene was the only carbapenemase found. Shock, dialysis, and age over 60 years were independent risk factors for death.
Internal Medicine Department, Londrina State University, Paraná, Brazil.
Claudia M D
CM
de Maio Carrilho
Microbiologist, Londrina, Brazil.
Larissa Marques
LM
de Oliveira
Microbiologist, Londrina, Brazil.
Juliana
J
Gaudereto
Postgraduate student, Londrina State University, Paraná, Brazil.
Jamile S
JS
Perozin
Statistics Department, Londrina State University, Paraná, Brazil.
Mariana Ragassi
MR
Urbano
Instituto Adolfo Lutz, Centro de Bacteriologia, São Paulo, Brazil.
Carlos H
CH
Camargo
Internal Medicine Department, Londrina State University, Paraná, Brazil.
Cintia M C
CM
Grion
Infectious Diseases Department, University of State of São Paulo, São Paulo, Brazil.
Anna Sara S
AS
Levin
Infectious Diseases Department, University of State of São Paulo, São Paulo, Brazil. costasilviaf@ig.com.br.|Infectious Diseases Department of Medicine School of University of São Paulo, Avenida Doutor Enéas de Carvalho Aguiar, 470, São Paulo, SP, 05403-000, Brazil. costasilviaf@ig.com.br.
Silvia F
SF
Costa
D000328:Adult; D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000235:genetics; D015780:Carbapenems / Q000494:pharmacology; D015331:Cohort Studies; D003091:Colistin / Q000494:pharmacology / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D004755:Enterobacteriaceae / Q000187:drug effects / Q000235:genetics / Q000502:physiology*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D006435:Renal Dialysis; D012307:Risk Factors; D012772:Shock, Septic / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D001618:beta-Lactamases / Q000235:genetics
D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D001618:beta-Lactamases; C063912:carbapenemase; D003091:Colistin
Bacterial; Carbapenems; Colistin; Drug resistance; Enterobacteriaceae; Multiple