In a prospective observational cohort study, 842 hospitalized patients with a clinical CRAb culture were enrolled at 46 hospitals in five global regions between 2017 and 2019. The primary outcome was all-cause mortality at 30 days from the index culture. The strains underwent whole-genome analysis.
Of 842 cases, 536 (64%) represented infection. By 30 days, 128 (24%) of the infected patients died, ranging from 1 (6%) of 18 in Australia-Singapore to 54 (25%) of 216 in the United States and 24 (49%) of 49 in South-Central America, whereas 42 (14%) of non-infected patients died. Bacteremia was associated with a higher risk of death compared with other types of infection (40 [42%] of 96 vs 88 [20%] of 440). In a multivariable logistic regression analysis, bloodstream infection and higher age-adjusted Charlson comorbidity index were independently associated with 30-day mortality. Clonal group 2 (CG2) strains predominated except in South-Central America, ranging from 216 (59%) of 369 in the United States to 282 (97%) of 291 in China. Acquired carbapenemase genes were carried by 769 (91%) of the 842 isolates. CG2 strains were significantly associated with higher levels of meropenem resistance, yet non-CG2 cases were over-represented among the deaths compared with CG2 cases.
CRAb infection types and clinical outcomes differed significantly across regions. Although CG2 strains remained predominant, non-CG2 strains were associated with higher mortality. Clinical Trials Registration. NCT03646227.
方法:在一项前瞻性观察性队列研究中,在2017年至2019年期间,在全球五个地区的46家医院招募了842名临床CRAb培养的住院患者。主要结果是指标培养后30天的全因死亡率。对菌株进行全基因组分析。
结果:842例,536(64%)代表感染。到30天,128名(24%)感染者死亡,从澳大利亚-新加坡的18个中的1个(6%)到美国的216个中的54个(25%)和中南美洲的49个中的24个(49%),而42(14%)的未感染患者死亡。与其他类型的感染相比,菌血症与更高的死亡风险相关(96例感染中的40[42%]440的88[20%])。在多变量逻辑回归分析中,血流感染和较高的年龄校正Charlson合并症指数与30日死亡率独立相关.克隆第2组(CG2)菌株占主导地位,中南美洲除外,从美国369人中的216人(59%)到中国291人中的282人(97%)不等。获得的碳青霉烯酶基因由842个分离株中的769个(91%)携带。CG2菌株与较高水平的美罗培南抗性显著相关,然而,与CG2病例相比,非CG2病例的死亡比例过高.
结论:各地区的CRAb感染类型和临床结局差异显著。虽然CG2菌株仍然占优势,非CG2菌株与较高的死亡率相关.
背景:#NCT03646227。