Mortality rate and factors associated with mortality of carbapenem-resistant Enterobacteriaceae infection

IF 2 Q3 PHARMACOLOGY & PHARMACY
Apichart So-ngern, Naphol Osaithai, Atibordee Meesing, Worawat Chumpangern
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Abstract

Background: Carbapenem-resistant Enterobacteriaceae (CRE) is a serious pathogen with high mortality. Recognition of factors associated with mortality and treating these modifiable factors are crucial to reducing mortality.Objective: To determine the 30-day mortality and factors associated with a 30-day mortality of CRE infection.Methods: A retrospective cohort study was conducted between January 1, 2015, and December 31, 2019. All patients diagnosed with CRE infection aged ≥18 years were included. Multivariate logistic regression was used for evaluating the factors associated with 30-day mortality and presented as adjusted odds ratio (aOR) with 95% confidence interval (CI).Result: One hundred and ninety-four patients were enrolled. The 30-day mortality occurred in 75 patients (38.7%). The common antibiotic regimen was monotherapy and combination of carbapenem, colistin, amikacin, tigecycline, and fosfomycin. CRE isolates were susceptible to tigecycline (93.8%), colistin (91.8%), fosfomycin (89.2%), and amikacin (89.2%). The independent factors associated with 30-day mortality were an increasing simplified acute physiology (SAP) II score (aOR 1.11, 95% CI 1.05-1.16, p < 0.001), sepsis at time of CRE infection diagnosis (aOR 7.93, 95% CI 2.21-28.51, p = 0.002), pneumonia (aOR 4.48, 95% CI 1.61-12.44, p = 0.004), monotherapy (aOR 4.69, 95% CI 1.71-12.85, p = 0.003), and improper empiric antibiotic (aOR 5.13, 95% CI 1.83-14.40, p = 0.002).Conclusion: The overall 30-day mortality of CRE infection was high. The factors associated with mortality were an increasing SAP II score, sepsis at time of CRE infection diagnosis, pneumonia, monotherapy, and improper empiric antibiotic. The study suggested that proper empiric antibiotic and combination antibiotics might reduce mortality from CRE infection.
碳青霉烯耐药肠杆菌科感染的死亡率及其相关因素
背景:碳青霉烯耐药肠杆菌科(CRE)是一种致死率高的严重病原菌。认识到与死亡率有关的因素并处理这些可改变的因素对降低死亡率至关重要。目的:了解CRE感染的30天死亡率及其相关因素。方法:2015年1月1日至2019年12月31日进行回顾性队列研究。所有年龄≥18岁诊断为CRE感染的患者纳入研究。多因素logistic回归用于评估与30天死亡率相关的因素,并以校正优势比(aOR)表示,95%置信区间(CI)。结果:共纳入194例患者。30天死亡75例(38.7%)。常见的抗生素治疗方案为单药治疗和碳青霉烯、粘菌素、阿米卡星、替加环素、磷霉素联合治疗。CRE分离株对替加环素(93.8%)、粘菌素(91.8%)、磷霉素(89.2%)、阿米卡星(89.2%)敏感。与30天死亡率相关的独立因素是简化急性生理(SAP) II评分增加(aOR 1.11, 95% CI 1.05-1.16, p <0.001)、CRE感染诊断时的脓毒症(aOR 7.93, 95% CI 2.21 ~ 28.51, p = 0.002)、肺炎(aOR 4.48, 95% CI 1.61 ~ 12.44, p = 0.004)、单药治疗(aOR 4.69, 95% CI 1.71 ~ 12.85, p = 0.003)和不当的经验抗生素(aOR 5.13, 95% CI 1.83 ~ 14.40, p = 0.002)。结论:CRE感染30天总死亡率较高。与死亡率相关的因素是SAP II评分升高、CRE感染诊断时的败血症、肺炎、单一治疗和不正确的经验性抗生素。研究表明,适当的经验性抗生素和联合抗生素可降低CRE感染的死亡率。
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来源期刊
Drug Target Insights
Drug Target Insights PHARMACOLOGY & PHARMACY-
CiteScore
2.70
自引率
0.00%
发文量
5
审稿时长
8 weeks
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