Drug resistance of CRE in hospital-acquired infections and clinical outcomes of infected patients

DENG Yong; MAO Ping; HE Yanhong; ZHANG Mei; WENG Jian

PDF(973 KB)

Medical Journal of the Chinese People Armed Police Forces ›› 2024, Vol. 35 ›› Issue (7) : 621-626.

ORIGINAL ARTICLES

Drug resistance of CRE in hospital-acquired infections and clinical outcomes of infected patients

DENG Yong, MAO Ping, HE Yanhong, ZHANG Mei, WENG Jian

Author information +

History +

Abstract

Objective To investigate the drug resistance of carbapenem-resistant enterobacteriaceae (CRE) in hospital-acquired infections and the clinical outcomes of infected patients. Methods A total of 341 adult patients with CRE infection hospitalized in Sichuan Provincial Corps Hospital of Chinese People’s Armed Police Force from January 2017 to June 2023 were selected as the case group, 336 patients with carbapenem sensitive enterobacteriidae (CSE) infection were selected as the sensitive group, and 354 hospitalized patients with non-enterobacteriidae infection during the same period were selected as the control group. The minimum inhibitory concentration of commonly used antibiotics to CRE were detected by drug sensitive strip and broth dilution method, and univariate and multivariate methods were used to analyze the clinical outcomes of hospital-acquired CRE patients. Results The most common types of CRE were sputum, urine and blood, and the top three types of CRE were carbapenem-resistant Klebsiella pneumoniae(CR-Kp), carbapenem-resistant Escherichia coli (CR-Eco) and carbapenem-resistant Enterobacter cloacae (CR-Ecl). Tigecycline and colistin were the top two sensitive drugs of CR-Kpn and CR-Eco in vitro. The sensitivity rate of tetracycline to CR-Kpn was 71.86%, while the sensitivity rate of tetracycline to CR-Eco was low. The sensitivity rate of nitrofuranins and aminoglycosides to CR-Eco was significantly higher than that of CR-Kpn. There was no significant difference in in-hospital mortality between CRE group and the other two groups (P>0.05), but the poor prognosis rate of CRE group (19.35%) was higher than that of CSE group (11.31%) and control group (12.15%), with statistical significance (P<0.05). In patients with CRE infection, renal insufficiency and the use of immunosuppressive agents were independent predictors of poor prognosis, while the empirical use of antibiotics was a protective factor. Conclusions Colistin and tigecycline have higher antibacterial activity against CRE than other commonly used antibiotics. Nitrofurantoin and aminoglycoside antibiotics are suitable for infection caused by CR-Eco. Hospital-acquired CRE infection is prone to lead to poor prognosis in patients, but the empirical use of antibiotics can effectively reduce the adverse clinical outcomes caused by CRE infection.

Key words

carbapenem-resistant enterobacteriaceae / drug resistance / clinical outcome

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

DENG Yong, MAO Ping, HE Yanhong, ZHANG Mei, WENG Jian. Drug resistance of CRE in hospital-acquired infections and clinical outcomes of infected patients[J]. Medical Journal of the Chinese People Armed Police Forces. 2024, 35(7): 621-626

References

[1] Yigit H, Queenan A M, Anderson G J, et al. Novel carbapenem-hydrolyzing beta-lactamase, kpc-1, from a carbapenem-resistant strain of klebsiella pneumoniae[J]. Antimicrob Agents Chemother, 2001, 45(4): 1151-1161.
[2] Wangchinda W, Thamlikitkul V, Watcharasuwanseree S, et al. Active surveillance for carbapenem-resistant enterobacterales (CRE) colonization and clinical course of cre colonization among cospitalized patients at a university hospital in Thailand[J]. Antibiotics (Basel), 2022, 11(10):1401.
[3] Sharma K, Tak V, Nag V L, et al. An observational study on carbapenem-resistant enterobacterales (CRE) colonisation and subsequent risk of infection in an adult intensive care unit (ICU) at a tertiary care hospital in India[J]. Infect Prev Pract, 2023, 5(4): 100312.
[4] Castanheira M, Deshpande L M, Mendes R E, et al. Prevalence of carbapenemase genes among carbapenem-nonsusceptibleenterobacterales collected in US hospitals in a five-year period and activity of ceftazidime/avibactam and comparator agents[J]. JAC Antimicrob Resist, 2022, 4(5): 98.
[5] Brown A L, van Kamp I. WHO environmental noise guidelines for the european region: asystematic review of transport noise interventions and their impacts on health[J]. Int J Environ Res Public Health, 2017, 14(8):873.
[6] Saito S, Hayakawa K, Tsuzuki S, et al. A matched case-case-control study of the impact of clinical outcomes and risk factors of patients with imp-type carbapenemase-producing carbapenem-resistant enterobacteriaceae in Japan[J]. Antimicrob Agents Chemother, 2021, 65(3):e01483-20.
[7] Madney Y, Aboubakr S, Khedr R, et al. Carbapenem-resistant enterobacteriaceae (CRE) among children with cancer: predictors of mortality and treatment outcome[J]. Antibiotics (Basel), 2023, 12(2):405.
[8] Chen Y, Wang W L, Zhang W, et al. Risk factors and outcomes of carbapenem-resistant enterobacteriaceae infection after liver transplantation: a retrospective study in a Chinese population[J]. Infect Drug Resist, 2020, 13: 4039-4045.
[9] Horan T C M, Andrus M R B C, Dudeck M A M. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting[J]. AJIC, 2008, 36(5): 309-332.
[10] 全国细菌耐药监测网.2014-2019年耐碳青霉烯类肺炎克雷伯菌流行病学变迁[J]. 中国感染控制杂志, 2021, 20(2): 175-179.
[11] Tamma P D, Aitken S L, Bonomo R A, et al. Infectious diseases society of America guidance on the treatment of extended-spectrum beta-lactamase producing enterobacterales (ESBL-e), carbapenem-resistant enterobacterales (CRE), and pseudomonas aeruginosa with difficult-to-treat resistance (dtr-p. aeruginosa)[J]. Clin Infect Dis, 2021, 72(7): e169-e183.
[12] Zhang Y, Wang Q, Yin Y, et al. Epidemiology of carbapenem-resistant enterobacteriaceae infections: report from the China crenetwork[J]. Antimicrob Agents Chemother, 2018, 62(2) : e01882-17.
[13] 张梅,谢祥红,魏文波,等. 武警某部医院碳青霉烯耐药肺炎克雷伯菌的耐药基因分析[J]. 武警医学, 2021, 32(1): 38-41.
[14] Cassini A, Hogberg L D, Plachouras D, et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis[J]. Lancet Infect Dis, 2019, 19(1): 56-66.
[15] Wang M, Earley M, Chen L, et al. Clinical outcomes and bacterial characteristics of carbapenem-resistant klebsiella pneumoniae complex among patients from different global regions (crackle-2): a prospective, multicentre, cohort study[J]. Lancet Infect Dis, 2022, 22(3): 401-412.
[16] Bernas A A, Aveiga V D, Etxeberria Z L, et al. Acute pancreatitis in ICU secondary to treatment with tigecycline[J]. Rev Esp Anestesiol Reanim, 2017, 64(1): 46-49.
[17] Humphries R, Bobenchik A M, Hindler J A, et al. Overview of changes to the clinical and laboratory standards institute performance standards for antimicrobial susceptibility testing, m100, 31st edition[J]. J Clin Microbiol, 2021, 59(12): e21321.
[18] Aleidan F, Alkhelaifi H, Alsenaid A, et al. Incidence and risk factors of carbapenem-resistant enterobacteriaceae infection in intensive care units: a matched case-control study[J]. Expert Rev Anti Infect Ther, 2021, 19(3): 393-398.
[19] Ruvinsky S, Voto C, Roel M, et al. Carbapenem-resistant enterobacteriaceae bloodstream infections: a case-control study from a pediatric referral hospital in Argentina[J]. Front Public Health, 2022, 10: 983174.
[20] Saito S, Hayakawa K, Tsuzuki S, et al. A matched case-case-control study of the impact of clinical outcomes and risk factors of patients with imp-type carbapenemase-producing carbapenem-resistant enterobacteriaceae in Japan[J]. Antimicrob Agents Chemother, 2021, 65(3): e01483-20.
[21] Tian X, Sun S, Jia X, et al. Epidemiology of and risk factors for infection with extended-spectrum beta-lactamase-producing carbapenem-resistant enterobacteriaceae: results of a double case-control study[J]. Infect Drug Resist, 2018, 11: 1339-1346.
[22] Li C, Li Y, Zhao Z, et al. Treatment options and clinical outcomes for carbapenem-resistantenterobacteriaceae bloodstream infection in a Chinese university hospital[J]. J Infect Public Health, 2019, 12(1): 26-31.
[23] Seo H, Lee S C, Chung H, et al. Clinical and microbiological analysis of risk factors for mortality in patients with carbapenem-resistant enterobacteriaceae bacteremia[J]. Int J Antimicrob Agents, 2020, 56(4): 106126.