Bloodstream Infections Caused by Carbapenem-Resistant Enterobacterales: Risk Factors for Mortality, Antimicrobial Therapy and Treatment Outcomes from a Prospective Multicenter Study
Authors Zhou C, Jin L, Wang Q, Wang X, Chen F, Gao Y, Zhao C, Chen H, Cao B, Wang H
Received 1 December 2020
Accepted for publication 7 January 2021
Published 24 February 2021 Volume 2021:14 Pages 731—742
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Suresh Antony
Chaoe Zhou,1 Longyang Jin,1 Qi Wang,1 Xiaojuan Wang,1 Fengning Chen,1 Yue Gao,1 Chunjiang Zhao,1 Hongbin Chen,1 Bin Cao,2 Hui Wang1
1Department of Clinical Microbiology, Peking University People’s Hospital, Beijing, People’s Republic of China; 2Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of China
Correspondence: Hui Wang
Department of Clinical Laboratory, Peking University People’s Hospital, Beijing, 100044, People’s Republic of China
Purpose: Carbapenem-resistant Enterobacterales bloodstream infections (CRE BSIs) have a high mortality. However, an optimal antimicrobial treatment has not been determined. This study was conducted to evaluate the risk factors for mortality and provided potential therapeutic options for treatment of CRE infection.
Patients and Methods: We investigated patients with CRE BSIs from 18 hospitals across nine Chinese provinces from January to December 2019. Data were collected from the medical records according to a pre-established questionnaire. Antimicrobial susceptibility testing and DNA sequencing were performed to investigate the characteristics of isolates.
Results: A total of 208 patients enrolled; the overall 30-day mortality rate was 46.2%. The causative pathogen was carbapenem-resistant Klebsiella pneumoniae (CRKP) (85.6%). Patients infected by ST11-KL64 CRKP had a high sepsis/septic shock incidence rate (p < 0.05). Sepsis/septic shock, short duration of antimicrobial therapy and empirical using tigecycline were independent risk factors for mortality (p < 0.05 for each risks). Appropriate therapy had better survival benefit than inappropriate therapy (p = 0.003). No difference was identified between monotherapy and combination therapy (p = 0.105). Tigecycline as a frequently used antimicrobial had poor therapeutic effect on BSI patients (p < 0.001). Carbapenem-based treatment had a better therapeutic effect on patients infected by isolates with meropenem MIC ≤ 8 mg/L (p = 0.022). The patients who received short duration of antimicrobial therapy had poorer prognosis (p < 0.001) than the patients who received long duration of antimicrobial therapy.
Conclusion: Reducing the mortality of CRE BSIs need to comprehensively consider whether the antimicrobials were used appropriately, together with infection severity and CRE strains.
Keywords: carbapenem-resistant Enterobacterales, bloodstream infections, risk factors, antimicrobial therapy, treatment outcomes
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