Epidemiology and clinical outcomes of infections caused by carbapenemase-producing Enterobacterales at a secondary-care hospital in China

IF 3.7 3区医学 Q2 INFECTIOUS DISEASES

Journal of global antimicrobial resistance Pub Date : 2026-09-01 Epub Date: 2026-08-13 DOI:10.1016/j.jgar.2026.08.010

Wen Zhu, Yi Liang, Feifei Dai

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引用次数: 0

Abstract

Objective

To analyse clinical characteristics of carbapenemase-producing Enterobacterales (CPE) infection and explore factors associated with their short-term (30-day) and long-term (90-day) prognostic outcomes.

Methods

A retrospective cohort study enrolled 192 nonduplicate patients with microbiologically confirmed CRE infection between January 2023 and June 2025 at a secondary-care hospital. All isolates underwent carbapenemase detection. Demographic data, clinical features, laboratory findings, treatment interventions, and 30-day/90-day prognostic outcomes were collected. Kaplan–Meier survival curves were generated, and the Log-rank tests were used for intergroup survival comparison. Univariate and multivariate Cox proportional hazards regression models were employed to identify independent prognostic factors for 30-day and 90-day mortality.

Results

All CRE isolates were confirmed as carbapenemase producers, with significant antimicrobial susceptibility differences. The 30-day and 90-day all-cause mortality rates were 23.43% (95% CI: 17.39%–29.48%) and 27.60% (95% CI: 21.22%–33.98%), respectively. Multivariate analyses revealed independent associations with 30-day mortality, including septic shock/sepsis (aHR = 2.528, 95% CI: 1.126–5.678), fasting plasma glucose (aHR = 1.113, 95% CI: 1.034–1.197), and hospital-onset infection (aHR = 2.246, 95% CI: 1.145–4.406). For 90-day mortality, additional factors included albumin infusion (aHR = 3.081, 95% CI: 1.350–7.096) and MBL type (aHR = 2.410, 95% CI: 1.301–4.465). Appropriate antimicrobial therapy was significantly associated with reduced 30-day (aHR = 0.424, 95% CI: 0.219–0.823) and 90-day (aHR = 0.346, 95% CI: 0.182–0.659) mortality risk.

Conclusions

Secondary-care hospitals present high prevalence of CPE, accompanied by a substantial mortality burden among infected patients. This study provides evidence-based guidance for optimising CPE management.

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中国一家二级医院产碳青霉烯酶肠杆菌感染的流行病学和临床结果

目的：分析产碳青霉烯酶肠杆菌（CPE）感染的临床特点，探讨影响其短期（30天）和长期（90天）预后的相关因素。方法：一项回顾性队列研究纳入了2023年1月至2025年6月在一家二级护理医院接受微生物学证实的192例非重复CRE感染患者。所有分离株进行碳青霉烯酶检测。收集人口统计学资料、临床特征、实验室结果、治疗干预措施和30天/90天预后。生成Kaplan-Meier生存曲线，采用Log-rank检验进行组间生存比较。采用单因素和多因素Cox比例风险回归模型确定影响30天和90天死亡率的独立预后因素。结果：所有CRE分离株均为碳青霉烯酶产生菌，且药敏差异显著。30天和90天的全因死亡率分别为23.43% （95% CI: 17.39 ~ 29.48%）和27.60% （95% CI: 21.22 ~ 33.98%）。多变量分析显示与30天死亡率的独立关联，包括感染性休克/败血症（aHR = 2.528,95% CI: 1.126-5.678）、空腹血糖（aHR = 1.113,95% CI: 1.034-1.197）和住院感染（aHR = 2.246,95% CI: 1.145-4.406）。对于90天死亡率，其他因素包括白蛋白输注（aHR = 3.081,95% CI: 1.350-7.096）和MBL类型（aHR = 2.410,95% CI: 1.301-4.465）。适当的抗菌药物治疗与降低30天（aHR = 0.424,95% CI: 0.219-0.823）和90天（aHR = 0.346,95% CI: 0.182-0.659）死亡风险显著相关。结论：二级医院CPE发病率高，感染患者死亡率高。本研究为优化CPE管理提供循证指导。

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来源期刊

Journal of global antimicrobial resistance INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY

CiteScore

8.70

自引率

2.20%

发文量

285

审稿时长

34 weeks

期刊介绍： The Journal of Global Antimicrobial Resistance (JGAR) is a quarterly online journal run by an international Editorial Board that focuses on the global spread of antibiotic-resistant microbes. JGAR is a dedicated journal for all professionals working in research, health care, the environment and animal infection control, aiming to track the resistance threat worldwide and provides a single voice devoted to antimicrobial resistance (AMR). Featuring peer-reviewed and up to date research articles, reviews, short notes and hot topics JGAR covers the key topics related to antibacterial, antiviral, antifungal and antiparasitic resistance.