نبذة مختصرة : Objectives: To determine the mortality-related risk factors for carbapenem-resistant Enterobacteriaceae (CRE) infection in hospitalized patients and to compare the clinical efficacy of different antimicrobial regimen.
Methods: Data were retrospectively collected from a 3,500-bed regional medical center between January 2021 and June 2022. Mortality-related risk factors were analyzed by the Cox proportional regression model for multivariate analysis.
Results: 120 patients were included and the all-cause mortality was 20.8% (25/120). Multivariate analysis showed that age (HR = 1.035, 95%CI: 1.002-1.070, P = 0.036), SOFA score (HR = 1.169,95%CI: 1.066-1.281, P = 0.001), central venous catheter (HR = 3.858, 95%CI: 1.411-10.547, P = 0.009), the length of hospital stay (HR = 0.868, 95% CI: 0.806-0.936, P = 0.000) and combination therapy (HR = 3.152, 95%CI: 1.205-8.245, P = 0.019) were independent mortality risk factors after CRE infection. All patients received definitive therapy and 65.0% (78/120) received sensitive drug treatment. Among those 65.4% (51/78) received combination therapy and 34.6% (27/78) received monotherapy. Subgroup analysis of the non-sepsis group showed significantly lower mortality in monotherapy than in combination therapy (0% versus 22.2%, P = 0.034). Patients who received carbapenem-containing therapy had significantly higher mortality than those who received carbapenem-sparing therapy (31.3% versus 13.9%, P = 0.022). CAZ-AVI-containing therapy presented a lower mortality (19.0%) and a higher 7-day microbiological clearance (47.6%) compared to other antimicrobial regimens, but there were no statistical significance (P>0.05).
Conclusions: Patients with older age, higher SOFA score, central venous catheter, shorter hospital stay after CRE infection may had poor outcomes. Since patients with non-sepsis have a lower mortality rate from monotherapy, combination antibiotic treatment should not be routinely recommended. Patients who received CAZ-AVI-containing therapy presented a lower mortality compared to other antimicrobial regimens without statistical significance, further larger sample size is needed for verification.
Competing Interests: Declarations. Ethics approval and consent to participate: This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki and was approved by the Medical Ethics Committee of Xiangya Hospital, Central South University, approval number [202109174]. Safety and fairness were fully considered in the trial design of this study. The content and results of the study would not cause harm or risk to the subjects, and there was no conflict of interest. Informed consent was obtained from all subjects involved in the study. For underage patients, the informed consent was obtained from the parents or legal guardians. For any deceased patients, it was obtained from the next of kin, for the use of their data in this study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Clinical trial: Clinical trial number: Not applicable.
(© 2025. The Author(s).)
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