期刊
INFECTION AND DRUG RESISTANCE
卷 11, 期 -, 页码 1339-1346出版社
DOVE MEDICAL PRESS LTD
DOI: 10.2147/IDR.S173456
关键词
risk factors; carbapenem; resistance; ESBL; mortality
资金
- National Natural Science Foundation of China [81471992, 81772239]
- Health and Family Planning Committee Foundation of Chongqing [2017MSXM009]
- Postgraduate Scientific Innovation Research Foundation of Chongqing [CYB17106]
Purpose: Carbapenem-resistant Enterobacteriaceae (CRE) have been increasingly reported worldwide and pose a serious public threat, but the clinical significance of extended-spectrum beta-lactamase (ESBL) production in CRE is not well established. Patients and methods: A retrospective case-case-control study was conducted to identify the clinical characteristics of patients with ESBL-CRE. The susceptibility of isolates obtained from these patients was assessed. The detection of ESBL and carbapenemase-related genes was performed by PCR methods. Predictors of 30-day mortality in patients with ESBL-CRE infection were also identified in our study. Results: A total of 149 patients with CRE infection caused by Enterobacter cloacae (n=74), Escherichia coli (n=38), and Klebsiella pneumoniae (n=37) were identified in Chongqing, Southwestern China, between January 2011 and December 2014. Of the 35 isolates detected with carbapenemase-related genes, 16 isolates had New Delhi metallo-beta-lactamase (NDM), nine isolates had K. pneumoniae carbapenemase (KPC), seven isolates had imipenemase (IMP), and four isolates had oxacillinase (OXA)-1. One strain of enterobacter cloacae carried both NDM-1 and IMP-8 genes. ESBL isolates included the genes CTX-M (72/149), SHV (64/149), and TEM (54/149). All ESBL-CRE isolates exhibited ertapenem resistance, and the rate of cephalosporin resistance was relatively high in general. Independent risk factors for infection with ESBL-CRE included previous exposure to beta-lactam antibiotics, transfer from another hospital, and some underlying diseases. In addition, solid tumors, hypoalbuminemia, and central venous catheters were independent predictors of mortality in patients with ESBL-CRE infection. Conclusion: Physicians should understand the peculiar predictors for the identification of these organisms among high-risk patients.
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