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Abstract：
The emergence of carbapenem-resistant Escherichia coli strains poses a considerable challenge to global public health, and little is known about carbapenemase-producing E. coli strains in Tianjin, China. This study aimed to investigate the risk factors for infections with carbapenem-resistant E. coli (CREC) strains. This retrospective case-control study was conducted at a tertiary teaching hospital. A total of 134 CREC clinical isolates were collected from the General Hospital of Tianjin Medical University between 2013 and 2020. The control group was selected at a ratio of 1:1 from patients with nosocomial carbapenem-susceptible E. coli infection. Risk factors for nosocomial CREC infection and clinical outcomes were analyzed using univariate and multivariate analyses. Multivariate analysis revealed that cephalosporin exposure (odd ratio OR = 2.01), carbapenem exposure (OR = 1.96), glucocorticoid exposure (OR = 32.45), and surgical history (OR = 3.26) were independent risk factors for CREC infection. The in-hospital mortality rate in the CREC group was 29.1%, and age >65 years (OR = 3.19), carbapenem exposure (OR = 3.54), and central venous catheter insertion (OR = 4.19) were independent risk factors for in-hospital mortality in patients with CREC infections. Several factors were identified in the development of nosocomial CREC infections. The CREC isolates were resistant to most antibiotics. Reducing CREC mortality requires a comprehensive consideration of appropriate antibiotic use, underlying diseases, and invasive procedures.IMPORTANCEEscherichia coli is an opportunistic pathogen that causes severe hospital-acquired infections. The spread of carbapenem-resistant E. coli is a global threat to public health, and only a few antibiotics are effective against these infections. Consequently, these infections are usually associated with poor prognosis and high mortality. Therefore, understanding the risk factors associated with the causes and outcomes of these infections is crucial to reduce their incidence and initiate appropriate therapies. In our study, several factors were found to be involved in nosocomial carbapenem-resistant E. coli (CREC) infections, and CREC isolates were resistant to most antibiotics. Reducing CREC mortality needs a comprehensive consideration of whether antibiotics are used appropriately, underlying diseases, and invasive interventions. These findings provide valuable evidence for the development of anti-infective therapy, infection prevention, and control of CREC-positive infections.
摘要：
耐碳青霉烯类大肠杆菌菌株的出现对全球公共卫生构成了相当大的挑战。对天津产碳青霉烯酶的大肠杆菌菌株知之甚少，中国。本研究旨在探讨耐碳青霉烯类大肠杆菌(CREC)感染的危险因素。这项回顾性病例对照研究是在三级教学医院进行的。2013年至2020年，天津医科大学总医院共收集到134株CREC临床分离株。以1:1的比例从医院内碳青霉烯类易感大肠杆菌感染的患者中选择对照组。使用单因素和多因素分析对医院CREC感染的危险因素和临床结局进行分析。多因素分析显示头孢菌素暴露（奇数比OR=2.01），碳青霉烯暴露(OR=1.96)，糖皮质激素暴露（OR=32.45），手术史(OR=3.26)是CREC感染的独立危险因素。CREC组住院死亡率为29.1%,年龄>65岁（OR=3.19），碳青霉烯暴露(OR=3.54)，中心静脉置管(OR=4.19)是CREC感染患者院内死亡的独立危险因素.在医院CREC感染的发展中确定了几个因素。CREC分离株对大多数抗生素具有抗性。降低CREC死亡率需要全面考虑适当的抗生素使用，潜在的疾病，和侵入性程序。IMPORTANCEE大肠杆菌是一种机会致病菌，可引起严重的医院获得性感染。耐碳青霉烯类大肠杆菌的传播是全球公共卫生的威胁,只有少数抗生素对这些感染有效。因此,这些感染通常与不良预后和高死亡率相关.因此,了解与这些感染的原因和结局相关的危险因素对于降低其发病率和启动适当的治疗至关重要.在我们的研究中,发现几个因素涉及医院耐碳青霉烯类大肠杆菌（CREC）感染，CREC分离株对大多数抗生素耐药。降低CREC死亡率需要综合考虑是否适当使用抗生素，潜在的疾病，和侵入性干预。这些发现为抗感染治疗的发展提供了有价值的证据,预防感染,并控制CREC阳性感染。
