Increased mortality in hospital- compared to community-onset carbapenem-resistant enterobacterales infections.

IF 3.9 2区 医学 Q1 INFECTIOUS DISEASES Journal of Antimicrobial Chemotherapy Pub Date : 2024-11-04 DOI:10.1093/jac/dkae306
Angelique E Boutzoukas, Natalie Mackow, Abhigya Giri, Lauren Komarow, Carol Hill, Liang Chen, Yohei Doi, Michael J Satlin, Cesar Arias, Minggui Wang, Laura Mora Moreo, Erica Herc, Eric Cober, Gregory Weston, Robin Patel, Robert A Bonomo, Vance Fowler, David van Duin
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Abstract

Background: The CDC reported a 35% increase in hospital-onset (HO) carbapenem-resistant Enterobacterales (CRE) infections during the COVID-19 pandemic. We evaluated patient outcomes following HO and community-onset (CO) CRE bloodstream infections (BSI).

Methods: Patients prospectively enrolled in CRACKLE-2 from 56 hospitals in 10 countries between 30 April 2016 and 30 November 2019 with a CRE BSI were eligible. Infections were defined as CO or HO by CDC guidelines, and clinical characteristics and outcomes were compared. The primary outcome was desirability of outcome ranking (DOOR) 30 days after index culture. Difference in 30-day mortality was calculated with 95% CI.

Results: Among 891 patients with CRE BSI, 65% were HO (582/891). Compared to those with CO CRE, patients with HO CRE were younger [median 60 (Q1 42, Q3 70) years versus 65 (52, 74); P < 0.001], had fewer comorbidities [median Charlson comorbidity index 2 (1, 4) versus 3 (1, 5); P = 0.002] and were more acutely ill (Pitt bacteraemia score ≥4: 47% versus 32%; P < 0.001). The probability of a better DOOR outcome in a randomly selected patient with CO BSI compared to a patient with HO BSI was 60.6% (95% CI: 56.8%-64.3%). Mortality at 30-days was 12% higher in HO BSI (192/582; 33%) than CO BSI [66/309 (21%); P < 0.001].

Conclusion: We found a disproportionately greater impact on patient outcomes with HO compared to CO CRE BSIs; thus, the recently reported increases in HO CRE infections by CDC requires rigorous surveillance and infection prevention methods to prevent added mortality.

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医院感染耐碳青霉烯类肠杆菌的死亡率高于社区感染。
背景:美国疾病预防控制中心(CDC)报告称,在 COVID-19 大流行期间,耐碳青霉烯类(HO)肠杆菌(CRE)的医院发病率增加了 35%。我们评估了耐碳青霉烯类和社区型(CO)CRE血流感染(BSI)患者的治疗效果:2016年4月30日至2019年11月30日期间,来自10个国家56家医院的CRACKLE-2前瞻性登记的CRE BSI患者符合条件。根据美国疾病预防控制中心(CDC)指南,感染被定义为CO或HO,并对临床特征和结局进行了比较。主要结果是指数培养后 30 天的结果可取性排名(DOOR)。计算30天死亡率的差异及95% CI:在 891 例 CRE BSI 患者中,65% 为 HO(582/891)。与CO CRE患者相比,HO CRE患者更年轻[中位数60(Q1 42,Q3 70)岁对65(52,74)岁;P 结论:我们发现CRE BSI对患者的影响更大:我们发现,与 CO CRE BSI 相比,HO CRE BSI 对患者预后的影响更大;因此,疾病预防控制中心最近报告的 HO CRE 感染增加需要严格的监控和感染预防方法,以防止增加死亡率。
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来源期刊
CiteScore
9.20
自引率
5.80%
发文量
423
审稿时长
2-4 weeks
期刊介绍: The Journal publishes articles that further knowledge and advance the science and application of antimicrobial chemotherapy with antibiotics and antifungal, antiviral and antiprotozoal agents. The Journal publishes primarily in human medicine, and articles in veterinary medicine likely to have an impact on global health.
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