PDF(Pubmed)
Abstract：
BACKGROUND: Carbapenem-resistant Klebsiella pneumoniae (Cr-Kpn) is becoming a growing public health problem through the failure of adequate treatment. This study\'s objectives are to describe the sources of Cr-Kpn in our hospital over 22 months, associating factors with the outcome of Cr-Kpn-positive patients, especially those with NDM+OXA-48-like (New Delhi Metallo-β-Lactamase and oxacillinase-48), and the effectiveness of the treatments used.
METHODS: A retrospective observational cohort study including all hospitalized patients with Cr-Kpn isolates. We reported data as percentages and identified independent predictors for mortality over hospital time through multivariate analysis.
RESULTS: The main type of carbapenemases identified were NDM+OXA-48-like (49.4%). The statistical analysis identified that diabetes and co-infections with the Gram-negative, non-urinary sites of infection were factors of unfavorable evolution. The Cox regression model identified factors associated with a poor outcome: ICU admission (HR of 2.38), previous medical wards transition (HR of 4.69), and carbapenemase type NDM (HR of 5.98). We did not find the superiority of an antibiotic regimen, especially in the case of NDM+OXA-48-like.
CONCLUSIONS: The increase in the incidence of Cr-Kpn infections, especially with NDM+OXA-48-like pathogens, requires a paradigm shift in both the treatment of infected patients and the control of the spread of these pathogens, which calls for a change in public health policy regarding the use of antibiotics and the pursuit of a One Health approach.
METHODS: A retrospective observational cohort study including all hospitalized patients with Cr-Kpn isolates. We reported data as percentages and identified independent predictors for mortality over hospital time through multivariate analysis.
RESULTS: The main type of carbapenemases identified were NDM+OXA-48-like (49.4%). The statistical analysis identified that diabetes and co-infections with the Gram-negative, non-urinary sites of infection were factors of unfavorable evolution. The Cox regression model identified factors associated with a poor outcome: ICU admission (HR of 2.38), previous medical wards transition (HR of 4.69), and carbapenemase type NDM (HR of 5.98). We did not find the superiority of an antibiotic regimen, especially in the case of NDM+OXA-48-like.
CONCLUSIONS: The increase in the incidence of Cr-Kpn infections, especially with NDM+OXA-48-like pathogens, requires a paradigm shift in both the treatment of infected patients and the control of the spread of these pathogens, which calls for a change in public health policy regarding the use of antibiotics and the pursuit of a One Health approach.
摘要：
背景：耐碳青霉烯类肺炎克雷伯菌（Cr-Kpn）由于缺乏适当的治疗而成为日益严重的公共卫生问题。本研究的目的是描述我院22个月以上Cr-Kpn的来源，与Cr-Kpn阳性患者预后相关的因素，尤其是那些与NDM+OXA-48-样（新德里金属-β-内酰胺酶和氧嘧啶酶-48），以及所用治疗方法的有效性。
方法：一项回顾性观察性队列研究，包括所有Cr-Kpn分离株住院患者。我们报告了百分比数据，并通过多变量分析确定了住院时间内死亡率的独立预测因素。
结果：确定的碳青霉烯酶的主要类型是NDM+OXA-48样（49.4%）。统计分析确定，糖尿病和与革兰氏阴性，非泌尿系感染部位是不良演变的因素。Cox回归模型确定了与不良预后相关的因素：ICU入院（HR为2.38），以前的医疗病房过渡(HR为4.69)，和碳青霉烯酶型NDM（HR为5.98）。我们没有发现抗生素疗法的优越性，特别是在NDM+OXA-48样的情况下。
结论：Cr-Kpn感染的发生率增加，尤其是NDM+OXA-48样病原体，需要在治疗感染患者和控制这些病原体传播方面进行范式转变，这要求改变有关使用抗生素和追求“一个健康”方法的公共卫生政策。
方法：一项回顾性观察性队列研究，包括所有Cr-Kpn分离株住院患者。我们报告了百分比数据，并通过多变量分析确定了住院时间内死亡率的独立预测因素。
结果：确定的碳青霉烯酶的主要类型是NDM+OXA-48样（49.4%）。统计分析确定，糖尿病和与革兰氏阴性，非泌尿系感染部位是不良演变的因素。Cox回归模型确定了与不良预后相关的因素：ICU入院（HR为2.38），以前的医疗病房过渡(HR为4.69)，和碳青霉烯酶型NDM（HR为5.98）。我们没有发现抗生素疗法的优越性，特别是在NDM+OXA-48样的情况下。
结论：Cr-Kpn感染的发生率增加，尤其是NDM+OXA-48样病原体，需要在治疗感染患者和控制这些病原体传播方面进行范式转变，这要求改变有关使用抗生素和追求“一个健康”方法的公共卫生政策。
