Infections due to carbapenemase-producing bacteria, clinical burden, and impact of screening strategies on outcome

IF 5 Q3 Medicine
Louise Abramowicz , Michèle Gerard , Delphine Martiny , Marc Delforge , Stéphane De Wit , Deborah Konopnicki
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引用次数: 5

Abstract

Objectives

To characterize the risk factors, impact of screening, and clinical burden of colonization and/or infection by carbapenemase-producing bacteria (CPB) in hospitalized patients.

Method

Retrospective study in a tertiary care hospital between 2008 and 2016.

Results

Among 88 included patients, 41% were colonized, 59% developed an infection, and 69% of all cases were hospital-acquired. Risk factors for CPB contamination included recent invasive medical device (94% of patients), antibiotic therapy (82%), travel abroad (17%), and hospitalization (> 50%) with 80% of all patients with underlying chronic condition. Intestinal carriage represented 89% of all colonization cases and 50% of infections were located in the urinary tract. The recent use of mechanical ventilation devices was significantly more observed in infected patients than colonized patients. The most frequent CPB was Klebsiella pneumoniae and the most frequent carbapenemase was OXA-48. Overall mortality rate was 19%. Prevalence of CPB detection in intensive care units (ICU) based on systematical rectal screen swab upon admission remained < 0.5%. The infected/colonized ratio (CPB colonization cases evolving into an infection) was 23%. The time between CPB infection diagnosis and start of appropriate antimicrobial therapy increased from 1 day in previously screened patients with positive CPB to 4 days in patients with previous negative or absent screening.

Conclusion

Our results emphasize the importance of CPB screening in all ICU patients and in at-risk patients hospitalized in other units, to allow earlier adequate antibiotic therapy in case of infection which occurred in 23% of the colonized patients.

碳青霉烯酶产生细菌引起的感染、临床负担和筛查策略对结果的影响
目的探讨住院患者碳青霉烯酶产菌(CPB)定植和/或感染的危险因素、筛查的影响和临床负担。方法2008 - 2016年在某三级医院进行回顾性研究。结果88例患者中,41%定植,59%发生感染,69%为医院获得性感染。CPB污染的危险因素包括近期侵入性医疗器械(94%的患者)、抗生素治疗(82%)、出国旅行(17%)和住院(>50%), 80%的患者有潜在的慢性疾病。肠道占所有定植病例的89%,50%的感染位于尿路。近期使用机械通气装置的感染患者明显多于定植患者。最常见的CPB是肺炎克雷伯菌,最常见的碳青霉烯酶是OXA-48。总死亡率为19%。重症监护病房(ICU)入院时系统直肠筛查拭子检测CPB的流行率保持不变。0.5%。感染/定植比率(CPB定植病例演变为感染)为23%。CPB感染诊断和开始适当抗菌药物治疗之间的时间从先前筛查的CPB阳性患者的1天增加到先前筛查阴性或未筛查的患者的4天。结论我们的研究结果强调了在所有ICU患者和其他单位住院的高危患者中进行CPB筛查的重要性,以便在23%的定群患者发生感染时及早给予充分的抗生素治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Medecine et maladies infectieuses
Medecine et maladies infectieuses 医学-传染病学
CiteScore
1.10
自引率
0.00%
发文量
0
审稿时长
10.7 weeks
期刊介绍: L''organe d''expression de la Société de Pathologie Infectieuse de Langue Française (SPILF). Médecine et Maladies Infectieuses is the official publication of the Société de Pathologie Infectieuse de Langue Française (SPILF). Médecine et Maladies Infectieuses is indexed in the major databases: Medline, Web of Science/Clarivate and Scopus. The journal publishes scientific /research articles, general reviews, short communications and letters, in both English and French. The journal welcomes submissions on the various aspects of infectious pathologies and pathogenic agents. Médecine et Maladies Infectieuses focuses on clinical therapeutics, nosocomial infections, biology, prevention, as well as epidemiology and therapeutics.
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