Epidemiology, Treatment and Outcomes of Bloodstream Infections Due to MBL-Producing Enterobacterales in France: A Retrospective Study.

IF 4.6 2区医学 Q1 INFECTIOUS DISEASES

International Journal of Antimicrobial Agents Pub Date : 2025-09-19 DOI:10.1016/j.ijantimicag.2025.107630

Benoît Pilmis, Laurent Dortet

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引用次数: 0

Abstract

Objectives: Bloodstream infections (BSI) due to metallo-β-lactamase (MBL)-producing Enterobacterales are linked to high mortality, but data from France remain limited.

Methods: We conducted a retrospective multicenter study in 86 French hospitals including 156 adult patients with confirmed BSI due to MBL-producing Enterobacterales (January 2023-February 2025). The primary outcome was 30-day all-cause mortality. Secondary outcomes included in-hospital mortality and resistance profiles. Clinical features, treatment, and mortality risk factors were assessed.

Results: Day-7, 30-day and in-hospital mortality rates were 11.5%, 23.1% and 26.3%, respectively. Common treatments were ceftazidime-avibactam plus aztreonam (n=91), cefiderocol (n=24), and other active antibiotics (n=21). Independent predictors of mortality were ICU admission (aOR 2.96, 95% CI [1.12-7.88]), delay in active therapy (aOR per day 1.19, 95% CI [1.02-1.40]), and lack of source control (aOR 4.0, 95% CI [1.14-14.3]). Among patients receiving active therapy, 30-day mortality did not differ by regimen. Cefiderocol resistance (27.9%) was mainly seen in NDM-producing E. coli strains harboring penicillin-binding protein 3 (PBP3) modifications and CMY-type β-lactamases.

Conclusions: MBL-producing Enterobacterales BSIs are associated with high mortality. Early appropriate therapy and source control are critical. Resistance to last-line agents such as cefiderocol and aztreonam-avibactam calls for optimized empirical treatment guided by rapid diagnostics.

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法国产mbl肠杆菌引起的血流感染的流行病学、治疗和结果：一项回顾性研究。

目的：由产生金属β-内酰胺酶（MBL）的肠杆菌引起的血液感染（BSI）与高死亡率有关，但来自法国的数据仍然有限。方法：我们在86家法国医院进行了一项回顾性多中心研究，包括156名确诊因产mbl肠杆菌引起BSI的成年患者（2023年1月至2025年2月）。主要终点为30天全因死亡率。次要结局包括住院死亡率和耐药性。评估临床特征、治疗和死亡率危险因素。结果：第7天、30天和住院死亡率分别为11.5%、23.1%和26.3%。常用的治疗方法是头孢他啶-阿维巴坦加阿曲南（n=91）、头孢地罗（n=24）和其他活性抗生素（n=21）。死亡率的独立预测因子为ICU入院（aOR 2.96, 95% CI[1.12-7.88]）、延迟积极治疗（aOR每天1.19,95% CI[1.02-1.40]）和缺乏源头控制（aOR 4.0, 95% CI[1.14-14.3]）。在接受积极治疗的患者中，不同治疗方案的30天死亡率没有差异。头孢地罗耐药（27.9%）主要见于含有青霉素结合蛋白3 （PBP3）修饰和cmy型β-内酰胺酶的产ndm大肠杆菌菌株。结论：产mbl肠杆菌bsi与高死亡率相关。早期适当的治疗和源头控制至关重要。对头孢地罗和阿曲那南-阿维巴坦等最后一线药物的耐药性要求在快速诊断的指导下优化经验性治疗。

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来源期刊

International Journal of Antimicrobial Agents 医学-传染病学

CiteScore

21.60

自引率

0.90%

发文量

176

审稿时长

36 days

期刊介绍： The International Journal of Antimicrobial Agents is a peer-reviewed publication offering comprehensive and current reference information on the physical, pharmacological, in vitro, and clinical properties of individual antimicrobial agents, covering antiviral, antiparasitic, antibacterial, and antifungal agents. The journal not only communicates new trends and developments through authoritative review articles but also addresses the critical issue of antimicrobial resistance, both in hospital and community settings. Published content includes solicited reviews by leading experts and high-quality original research papers in the specified fields.