PDF(Pubmed)
Abstract：
Infections with carbapenemase-producing Gram-negative bacteria are related to increased morbidity and mortality, yet little is known regarding infections caused by non-beta-lactamase mediated carbapenem-resistant bacteria. Our objective was to identify risk factors for, and the clinical impact of infections caused by carbapenem-resistant carbapenemase-negative Enterobacterales and Pseudomonas aeruginosa. This retrospective matched case-control study was performed at the University Hospital of Basel, Switzerland, in 2016. We focused on other resistance mechanisms by excluding laboratory-confirmed carbapenemase-positive cases. Carbapenem resistance was set as the primary endpoint, and important risk factors were investigated by conditional logistic regression. The clinical impact of carbapenem resistance was estimated using regression models containing the resistance indicator as explanatory factor and adjusting for potential confounders. Seventy-five cases of infections with carbapenem-resistant, carbapenemase-negative bacteria were identified and matched with 75 controls with carbapenem-susceptible infections. The matched data set was well-balanced regarding age, gender, and comorbidity. Duration of prior carbapenem treatment (OR 1.15, [1.01, 1.31]) correlated with resistance to carbapenems. Our study showed that patients with carbapenem-resistant bacteria stayed 1.59 times (CI [0.81, 3.14]) longer in an ICU. The analyzed dataset did not provide evidence for strong clinical implications of resistance to carbapenems or increased mortality. The duration of prior carbapenem treatment seems to be a strong risk factor for the development of carbapenem resistance. The higher risk for a longer ICU stay could be a consequence of a carbapenem resistance. In contrast to carbapenemase-producers, the clinical impact of carbapenamase-negative, carbapenem-resistant strains may be limited. Trial registration: The study design was prospectively approved by the local Ethics Commission on 10.08.2017 (EKNZ BASEC 2017-00222).
摘要：
产生碳青霉烯酶的革兰氏阴性菌感染与发病率和死亡率增加有关。然而,对由非β-内酰胺酶介导的碳青霉烯类耐药细菌引起的感染知之甚少.我们的目标是确定风险因素，以及耐碳青霉烯酶阴性肠杆菌和铜绿假单胞菌引起的感染的临床影响。这项回顾性匹配的病例对照研究是在巴塞尔大学医院进行的，瑞士,2016年。通过排除实验室确认的碳青霉烯酶阳性病例，我们专注于其他耐药机制。碳青霉烯耐药被设定为主要终点，并对重要危险因素进行条件logistic回归分析。碳青霉烯类耐药的临床影响是使用包含耐药指标作为解释因素并调整潜在的混杂因素的回归模型来估计的。75例耐碳青霉烯感染，鉴定了碳青霉烯酶阴性菌，并与75例碳青霉烯类易感感染的对照进行匹配。匹配的数据集在年龄方面平衡良好，性别,和合并症。先前碳青霉烯治疗的持续时间（OR1.15，[1.01，1.31]）与对碳青霉烯的耐药性相关。我们的研究表明，耐碳青霉烯类细菌的患者在ICU中的停留时间延长了1.59倍（CI[0.81,3.14]）。分析的数据集没有提供碳青霉烯类耐药或死亡率增加的强烈临床意义的证据。先前碳青霉烯治疗的持续时间似乎是碳青霉烯耐药性发展的强烈危险因素。长期ICU住院的风险较高可能是碳青霉烯耐药的结果。与碳青霉烯酶生产者相反，碳青霉烯酶阴性的临床影响，耐碳青霉烯菌株可能有限。试验注册：研究设计于2017年8月10日获得当地伦理委员会的前瞻性批准（EKNZBASEC2017-00222）。
