Abstract
BackgroundThe increasing incidence of carbapenem-resistant Enterobacteriaceae (CRE), has resulted in a difficult problem in the current clinical anti-infective treatment. We performed a retrospective analysis of prevalence and treatment for CRE infections patients.MethodsThis study was conducted in three tertiary care hospitals from January 1, 2010 to December 30, 2016. Baseline data, treatment, and outcomes were collected in patients with ventilator-associated bacterial pneumonia (VABP), bacteremia, complicated urinary tract infection (cUTI)/acute pyelonephritis (AP), hospital-acquired bacterial pneumonia (HABP), superficial wound infection (SWI), biliary tract infection (BTI), deep wound infection (DWI) and sterile body fluids infection (SBFI) due to CRE.ResultsOne hundred twenty-four cases of CRE infection were identified: 31 VABP, 22 bacteremia, 18 cUTI/AP, 16 HABP, 16 SWI, 9 BTI, 7 DWI and 5 SBFI. The patient population had significant immunocompromised (33 of 124, 26.6%) and severe sepsis (43 of 124, 34.7%). The most common CRE pathogens were Klebsiella pneumoniae (84 of 124, 67.7%) and Enterobacter cloacae (24 of 124, 19.4%). And the production of IMP-type carbapenemase was the main antibiotic resistance mechanism. The majority of patients to take monotherapy for empiric therapy and dual therapy for direct treatment. Outcomes were universally poor (28-day mortality was 22.6%, 28 of 124) across all sites of infection.ConclusionsWe identified a large number of cases of CRE infection in 7 years from different parts, most of these pathogens have been confirmed to produce IMP-type carbapenemases. The retrospective analysis of cases of such bacterial infections will help to control future infections of these pathogens. Despite the high mortality rate, we still found that the selection of quinolone antibiotics can be effective in the treatment of CRE producing IMP type enzymes.
Highlights
The increasing incidence of carbapenem-resistant Enterobacteriaceae (CRE), has resulted in a difficult problem in the current clinical anti-infective treatment
Any patient who had clinical evidence of ventilator-associated bacterial pneumonia (VABP), bacteremia, complicated urinary tract infection/acute pyelonephritis (AP), hospital-acquired bacterial pneumonia (HABP), superficial wound infection (SWI), biliary tract infection (BTI), deep wound infection (DWI) and sterile body fluids infection (SBFI) requiring antimicrobial treatment was eligible for inclusion
VABP appeared a high incidence (64.5%) in the intensive care unit (ICU), while the complicated urinary tract infection (cUTI)/AP, SWI, BTI, DWI and SBFI have a high proportion in the surgical ward, accounting for 61.1, 75.0, 88.9, 57.1 and 80.0% respectively
Summary
The increasing incidence of carbapenem-resistant Enterobacteriaceae (CRE), has resulted in a difficult problem in the current clinical anti-infective treatment. A subsequent multisectoral study confirmed the presence of CRE strains in several districts and hospitals in China [8]. Due to their resistance to most available antimicrobial agents, invasive infections with these organisms have been associated with high rates of morbidity and mortality [9, 10], Studying the characteristics of clinical infection with CRE is conducive to the targeted treatment of this kind of infection. Our previous study has confirmed the presence of a large amount of IMP-producing carbapenemase CRE in three hospitals of Liaocheng city, in China. This study mainly focuses on the clinical data of pre-CRE strains in order to obtain the measures to control and treat infection of such strains
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