Abstract：
OBJECTIVE: The aim was to analyse the clinical and economic impact of carbapenemase-producing Enterobacterales (CPE) infections.
METHODS: Case-control study. Adult patients with CPE infections were considered cases, while those with non-CPE infections were controls. Matching criteria were age (± 5 years), sex, source of infection and microorganism (ratio 1:2). Primary outcome was 30-day mortality. Secondary outcomes were 90-day mortality, clinical failure, hospitalisation costs and resource consumption.
RESULTS: 246 patients (82 cases and 164 controls) were included. Klebsiella pneumoniae OXA-48 was the most common microorganism causing CPE infections. CPE cases had more prior comorbidities (p = 0.007), septic shock (p = 0.003), and were more likely to receive inappropriate empirical and definitive antibiotic treatment (both p < 0.001). Multivariate analysis identified septic shock and inappropriate empirical treatment as independent predictors for 7-day and end-of-treatment clinical failure, whereas Charlson Index and septic shock were associated with 30- and 90-day mortality. CPE infection was independently associated with early clinical failure (OR 2.18, 95% CI, 1.03-4.59), but not with end-of-treatment clinical failure or 30- or 90-day mortality. In terms of resource consumption, hospitalisation costs for CPE were double those of the non-CPE group. CPE cases had longer hospital stay (p < 0.001), required more long-term care facilities (p < 0.001) and outpatient parenteral antibiotic therapy (p = 0.007).
CONCLUSIONS: The CPE group was associated with worse clinical outcomes, but this was mainly due to a higher comorbidity burden, more severe illness, and more frequent inappropriate antibiotic treatment rather than resistance patterns as such. However, the CPE group consumed more healthcare resources and incurred higher costs.
METHODS: Case-control study. Adult patients with CPE infections were considered cases, while those with non-CPE infections were controls. Matching criteria were age (± 5 years), sex, source of infection and microorganism (ratio 1:2). Primary outcome was 30-day mortality. Secondary outcomes were 90-day mortality, clinical failure, hospitalisation costs and resource consumption.
RESULTS: 246 patients (82 cases and 164 controls) were included. Klebsiella pneumoniae OXA-48 was the most common microorganism causing CPE infections. CPE cases had more prior comorbidities (p = 0.007), septic shock (p = 0.003), and were more likely to receive inappropriate empirical and definitive antibiotic treatment (both p < 0.001). Multivariate analysis identified septic shock and inappropriate empirical treatment as independent predictors for 7-day and end-of-treatment clinical failure, whereas Charlson Index and septic shock were associated with 30- and 90-day mortality. CPE infection was independently associated with early clinical failure (OR 2.18, 95% CI, 1.03-4.59), but not with end-of-treatment clinical failure or 30- or 90-day mortality. In terms of resource consumption, hospitalisation costs for CPE were double those of the non-CPE group. CPE cases had longer hospital stay (p < 0.001), required more long-term care facilities (p < 0.001) and outpatient parenteral antibiotic therapy (p = 0.007).
CONCLUSIONS: The CPE group was associated with worse clinical outcomes, but this was mainly due to a higher comorbidity burden, more severe illness, and more frequent inappropriate antibiotic treatment rather than resistance patterns as such. However, the CPE group consumed more healthcare resources and incurred higher costs.
摘要：
目的：目的是分析产碳青霉烯酶肠杆菌（CPE）感染的临床和经济影响。
方法：病例对照研究。患有CPE感染的成年患者被认为是病例，而非CPE感染的患者为对照。匹配标准为年龄（±5岁），性别,感染源和微生物（比例1：2）。主要结果是30天死亡率。次要结果是90天死亡率，临床失败,住院费用和资源消耗。
结果：包括246例患者（82例和164例对照）。肺炎克雷伯菌OXA-48是引起CPE感染的最常见微生物。CPE病例先前有更多的合并症(p=0.007)，感染性休克（p=0.003），并且更有可能接受不适当的经验性和确定性抗生素治疗（均p<0.001）。多因素分析确定脓毒性休克和不适当的经验性治疗是7天和治疗结束临床失败的独立预测因素。而Charlson指数和脓毒性休克与30天和90天死亡率相关。CPE感染与早期临床失败独立相关(OR2.18,95%CI,1.03-4.59),但不是治疗结束时临床失败或30天或90天死亡率。在资源消耗方面,CPE的住院费用是非CPE组的两倍.CPE病例住院时间较长（p<0.001），需要更多的长期护理设施(p<0.001)和门诊肠外抗生素治疗(p=0.007).
结论：CPE组的临床结局较差，但这主要是由于较高的共病负担，更严重的疾病，更频繁的不适当的抗生素治疗，而不是耐药模式。然而,CPE集团消耗了更多的医疗资源，产生了更高的成本。
方法：病例对照研究。患有CPE感染的成年患者被认为是病例，而非CPE感染的患者为对照。匹配标准为年龄（±5岁），性别,感染源和微生物（比例1：2）。主要结果是30天死亡率。次要结果是90天死亡率，临床失败,住院费用和资源消耗。
结果：包括246例患者（82例和164例对照）。肺炎克雷伯菌OXA-48是引起CPE感染的最常见微生物。CPE病例先前有更多的合并症(p=0.007)，感染性休克（p=0.003），并且更有可能接受不适当的经验性和确定性抗生素治疗（均p<0.001）。多因素分析确定脓毒性休克和不适当的经验性治疗是7天和治疗结束临床失败的独立预测因素。而Charlson指数和脓毒性休克与30天和90天死亡率相关。CPE感染与早期临床失败独立相关(OR2.18,95%CI,1.03-4.59),但不是治疗结束时临床失败或30天或90天死亡率。在资源消耗方面,CPE的住院费用是非CPE组的两倍.CPE病例住院时间较长（p<0.001），需要更多的长期护理设施(p<0.001)和门诊肠外抗生素治疗(p=0.007).
结论：CPE组的临床结局较差，但这主要是由于较高的共病负担，更严重的疾病，更频繁的不适当的抗生素治疗，而不是耐药模式。然而,CPE集团消耗了更多的医疗资源，产生了更高的成本。
