Predictors for carbapenem-resistant bacteria as the pathogens of bloodstream infections_West China Medical Journal

Authors：

ZHU Shichao ^1,2 , YIN Weijia ^1,2 , ZHANG Hui ¹ , LI Jingwen ¹ , CAI Lin ³ , DENG Yuhua ¹ ,  ZONG Zhiyong ⁴

1. Department of Infection Control, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Infection Control, West China Tianfu Hospital, Sichuan University, Chengdu, Sichuan 610200, P. R. China;
3. Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
4. Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

ZONG Zhiyong, Email: zongzhiy@scu.edu.cn

Keywords：

Carbapenem-resistant Acinetobacter baumannii; carbapenem-resistant Enterobacteriaceae; carbapenem-resistant Pseudomonas aeruginosa; intensive care unit; bloodstream infection; predictor

DOI：

10.7507/1002-0179.202302089

Video：

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Objective To investigate the predictors for carbapenem-resistant Acinetobacter baumannii, Enterobacteriaceae and Pseudomonas aeruginosa (CR-AEP) as the pathogens of bloodstream infection (BSI) for intensive care unit (ICU) patients. Methods A retrospective case-control study based on ICU- healthcare-associated infection (HAI) research database was carried out. The patients who have been admitted to the central ICU between 2015 and 2019 in the ICU-HAI research database of West China Hospital of Sichuan University were selected. The included patients were divided into two groups, of which the patients with ICU-acquired BSI due to CR-AEP were the case group and the patients with BSI due to the pathogens other than CR-AEP were the control group. The clinical features of the two groups of patients were compared. Logistic regression model was used to identify the predictors of BSI due to CR-AEP.Results A total of 197 patients with BSI were included, including 83 cases in the case group and 114 cases in the control group. A total of 214 strains of pathogenic bacteria were isolated from the 197 BSI cases, including 86 CR-AEP strains. The results of multivariate logistic regression analysis showed that previous use of tigecycline [odds ratio (OR)=2.490, 95% confidence interval (CI) (1.141, 5.436), P=0.022] was associated with higher possibility for CR-AEP as the pathogens of BSI in ICU patients with BSI, while previous use of antipseudomonal penicillin [OR=0.497, 95%CI (0.256, 0.964), P=0.039] was associated with lower possibility for that. Conclusion Previous use of tigecycline or antipseudomonal penicillin is the predictor for CR-AEP as the pathogens of BSI in ICU patients with BSI.

Citation： ZHU Shichao, YIN Weijia, ZHANG Hui, LI Jingwen, CAI Lin, DENG Yuhua, ZONG Zhiyong. Predictors for carbapenem-resistant bacteria as the pathogens of bloodstream infections. West China Medical Journal, 2023, 38(3): 346-351. doi: 10.7507/1002-0179.202302089 Copy

1.	Routsi C, Pratikaki M, Platsouka E, et al. Risk factors for carbapenem-resistant Gram-negative bacteremia in intensive care unit patients. Intensive Care Med, 2013, 39(7): 1253-1261.
2.	MacVane SH. Antimicrobial resistance in the intensive care unit: a focus on Gram-negative bacterial infections. J Intensive Care Med, 2017, 32(1): 25-37.
3.	Hsu JY, Chuang YC, Wang JT, et al. Healthcare-associated carbapenem-resistant Klebsiella pneumoniae bloodstream infections: risk factors, mortality, and antimicrobial susceptibility, 2017-2019. J Formos Med Assoc, 2021, 120(11): 1994-2002.
4.	Sahbudak Bal Z, Bekmezci N, Soylu M, et al. The prospective evaluation of risk factors and clinical influence of carbapenem resistance in children with Gram-negative bacteria infection. Am J Infect Control, 2018, 46(2): 147-153.
5.	喬甫, 宗志勇. 世界衛生組織《醫療機構耐碳青霉烯的腸桿菌科細菌、銅綠假單胞菌和鮑曼不動桿菌防控指南》介紹. 華西醫學, 2018, 33(3): 259-263.
6.	Cerceo E, Deitelzweig SB, Sherman BM, et al. Multidrug-resistant Gram-negative bacterial infections in the hospital setting: overview, implications for clinical practice, and emerging treatment options. Microb Drug Resist, 2016, 22(5): 412-431.
7.	Jalali Y, Sturdik I, Jalali M, et al. Isolated carbapenem resistant bacteria, their multidrug resistant profile, percentage of healthcare associated infection and associated mortality, in hospitalized patients in a University Hospital in Bratislava. Bratisl Lek Listy, 2021, 122(6): 379-385.
8.	Wong SC, Chau PH, So SY, et al. Control of healthcare-associated carbapenem-resistant Acinetobacter baumannii by enhancement of infection control measures. Antibiotics (Basel), 2022, 11(8): 1076.
9.	Nicolas-Chanoine MH, Vigan M, Laouénan C, et al. Risk factors for carbapenem-resistant Enterobacteriaceae infections: a French case-control-control study. Eur J Clin Microbiol Infect Dis, 2019, 38(2): 383-393.
10.	Zhang Y, Chen XL, Huang AW, et al. Mortality attributable to carbapenem-resistant Pseudomonas aeruginosa bacteremia: a meta-analysis of cohort studies. Emerg Microbes Infect, 2016, 5(3): e27.
11.	嚴輝竹, 呂宇, 方英. 醫院感染耐碳青霉烯類腸桿菌科細菌的直接經濟負擔分析. 華西醫學, 2021, 36(3): 334-340.
12.	Vargas-Alzate CA, Higuita-Gutiérrez LF, López-López L, et al. High excess costs of infections caused by carbapenem-resistant Gram-negative bacilli in an endemic region. Int J Antimicrob Agents, 2018, 51(4): 601-607.
13.	王芳, 王群, 辛力華, 等. 某中醫院耐碳青霉烯類腸桿菌科細菌耐藥表型及耐藥基因分析. 華西醫學, 2020, 35(8): 912-917.
14.	胡必杰. 中國碳青霉烯耐藥革蘭陰性桿菌(CRO)感染預防與控制技術指引. 中華醫院感染學雜志, 2019, 29(13): 2075-2080.
15.	Ting SW, Lee CH, Liu JW. Risk factors and outcomes for the acquisition of carbapenem-resistant Gram-negative bacillus bacteremia: a retrospective propensity-matched case control study. J Microbiol Immunol Infect, 2018, 51(5): 621-628.
16.	Palacios-Baena ZR, Giannella M, Manissero D, et al. Risk factors for carbapenem-resistant Gram-negative bacterial infections: a systematic review. Clin Microbiol Infect, 2021, 27(2): 228-235.
17.	李惠萍, 高偉, 劉培, 等. 耐碳青霉烯鮑曼不動桿菌血流感染風險及耐藥性分析. 廣東藥科大學學報, 2022, 38(2): 55-61.
18.	胡蘭蘭, 李穎, 邵中軍, 等. 耐碳青霉烯鮑氏不動桿菌血流感染影響因素的Meta分析. 中華醫院感染學雜志, 2019, 29(8): 1136-1141.
19.	Meng H, Han L, Niu M, et al. Risk factors for mortality and outcomes in hematological malignancy patients with carbapenem-resistant Klebsiella pneumoniae bloodstream infections. Infect Drug Resist, 2022, 15: 4241-4251.
20.	Liu J, Wang H, Huang Z, et al. Risk factors and outcomes for carbapenem-resistant Klebsiella pneumoniae bacteremia in onco-hematological patients. J Infect Dev Ctries, 2019, 13(5): 357-364.
21.	Knaus WA, Draper EA, Wagner DP, et al. APACHE Ⅱ: a severity of disease classification system. Crit Care Med, 1985, 13(10): 818-829.
22.	Chen IL, Lee CH, Ting SW, et al. Prediction of imipenem-resistant microorganisms among the nosocomial critically ill patients with Gram-negative bacilli septicemia: a simple risk score. Infect Drug Resist, 2018, 11: 283-293.
23.	Chen HY, Jean SS, Lee YL, et al. Carbapenem-resistant Enterobacterales in long-term care facilities: a global and narrative review. Front Cell Infect Microbiol, 2021, 11: 601968.
24.	Xiao T, Zhu Y, Zhang S, et al. A retrospective analysis of risk factors and outcomes of carbapenem-resistant Klebsiella pneumoniae bacteremia in nontransplant patients. J Infect Dis, 2020, 221(Suppl 2): S174-S183.
25.	Cao Z, Yue C, Kong Q, et al. Risk factors for a hospital-acquired carbapenem-resistant Klebsiella pneumoniae bloodstream infection: a five-year retrospective study. Infect Drug Resist, 2022, 15: 641-654.
26.	孫雁, 鄭虹, 張堅磊, 等. 兒童肝移植術后耐碳青霉烯類腸桿菌科感染臨床特點分析. 中華兒科雜志, 2020, 58(8): 640-645.

1. Routsi C, Pratikaki M, Platsouka E, et al. Risk factors for carbapenem-resistant Gram-negative bacteremia in intensive care unit patients. Intensive Care Med, 2013, 39(7): 1253-1261.
2. MacVane SH. Antimicrobial resistance in the intensive care unit: a focus on Gram-negative bacterial infections. J Intensive Care Med, 2017, 32(1): 25-37.
3. Hsu JY, Chuang YC, Wang JT, et al. Healthcare-associated carbapenem-resistant Klebsiella pneumoniae bloodstream infections: risk factors, mortality, and antimicrobial susceptibility, 2017-2019. J Formos Med Assoc, 2021, 120(11): 1994-2002.
4. Sahbudak Bal Z, Bekmezci N, Soylu M, et al. The prospective evaluation of risk factors and clinical influence of carbapenem resistance in children with Gram-negative bacteria infection. Am J Infect Control, 2018, 46(2): 147-153.
5. 喬甫, 宗志勇. 世界衛生組織《醫療機構耐碳青霉烯的腸桿菌科細菌、銅綠假單胞菌和鮑曼不動桿菌防控指南》介紹. 華西醫學, 2018, 33(3): 259-263.
6. Cerceo E, Deitelzweig SB, Sherman BM, et al. Multidrug-resistant Gram-negative bacterial infections in the hospital setting: overview, implications for clinical practice, and emerging treatment options. Microb Drug Resist, 2016, 22(5): 412-431.
7. Jalali Y, Sturdik I, Jalali M, et al. Isolated carbapenem resistant bacteria, their multidrug resistant profile, percentage of healthcare associated infection and associated mortality, in hospitalized patients in a University Hospital in Bratislava. Bratisl Lek Listy, 2021, 122(6): 379-385.
8. Wong SC, Chau PH, So SY, et al. Control of healthcare-associated carbapenem-resistant Acinetobacter baumannii by enhancement of infection control measures. Antibiotics (Basel), 2022, 11(8): 1076.
9. Nicolas-Chanoine MH, Vigan M, Laouénan C, et al. Risk factors for carbapenem-resistant Enterobacteriaceae infections: a French case-control-control study. Eur J Clin Microbiol Infect Dis, 2019, 38(2): 383-393.
10. Zhang Y, Chen XL, Huang AW, et al. Mortality attributable to carbapenem-resistant Pseudomonas aeruginosa bacteremia: a meta-analysis of cohort studies. Emerg Microbes Infect, 2016, 5(3): e27.
11. 嚴輝竹, 呂宇, 方英. 醫院感染耐碳青霉烯類腸桿菌科細菌的直接經濟負擔分析. 華西醫學, 2021, 36(3): 334-340.
12. Vargas-Alzate CA, Higuita-Gutiérrez LF, López-López L, et al. High excess costs of infections caused by carbapenem-resistant Gram-negative bacilli in an endemic region. Int J Antimicrob Agents, 2018, 51(4): 601-607.
13. 王芳, 王群, 辛力華, 等. 某中醫院耐碳青霉烯類腸桿菌科細菌耐藥表型及耐藥基因分析. 華西醫學, 2020, 35(8): 912-917.
14. 胡必杰. 中國碳青霉烯耐藥革蘭陰性桿菌(CRO)感染預防與控制技術指引. 中華醫院感染學雜志, 2019, 29(13): 2075-2080.
15. Ting SW, Lee CH, Liu JW. Risk factors and outcomes for the acquisition of carbapenem-resistant Gram-negative bacillus bacteremia: a retrospective propensity-matched case control study. J Microbiol Immunol Infect, 2018, 51(5): 621-628.
16. Palacios-Baena ZR, Giannella M, Manissero D, et al. Risk factors for carbapenem-resistant Gram-negative bacterial infections: a systematic review. Clin Microbiol Infect, 2021, 27(2): 228-235.
17. 李惠萍, 高偉, 劉培, 等. 耐碳青霉烯鮑曼不動桿菌血流感染風險及耐藥性分析. 廣東藥科大學學報, 2022, 38(2): 55-61.
18. 胡蘭蘭, 李穎, 邵中軍, 等. 耐碳青霉烯鮑氏不動桿菌血流感染影響因素的Meta分析. 中華醫院感染學雜志, 2019, 29(8): 1136-1141.
19. Meng H, Han L, Niu M, et al. Risk factors for mortality and outcomes in hematological malignancy patients with carbapenem-resistant Klebsiella pneumoniae bloodstream infections. Infect Drug Resist, 2022, 15: 4241-4251.
20. Liu J, Wang H, Huang Z, et al. Risk factors and outcomes for carbapenem-resistant Klebsiella pneumoniae bacteremia in onco-hematological patients. J Infect Dev Ctries, 2019, 13(5): 357-364.
21. Knaus WA, Draper EA, Wagner DP, et al. APACHE Ⅱ: a severity of disease classification system. Crit Care Med, 1985, 13(10): 818-829.
22. Chen IL, Lee CH, Ting SW, et al. Prediction of imipenem-resistant microorganisms among the nosocomial critically ill patients with Gram-negative bacilli septicemia: a simple risk score. Infect Drug Resist, 2018, 11: 283-293.
23. Chen HY, Jean SS, Lee YL, et al. Carbapenem-resistant Enterobacterales in long-term care facilities: a global and narrative review. Front Cell Infect Microbiol, 2021, 11: 601968.
24. Xiao T, Zhu Y, Zhang S, et al. A retrospective analysis of risk factors and outcomes of carbapenem-resistant Klebsiella pneumoniae bacteremia in nontransplant patients. J Infect Dis, 2020, 221(Suppl 2): S174-S183.
25. Cao Z, Yue C, Kong Q, et al. Risk factors for a hospital-acquired carbapenem-resistant Klebsiella pneumoniae bloodstream infection: a five-year retrospective study. Infect Drug Resist, 2022, 15: 641-654.
26. 孫雁, 鄭虹, 張堅磊, 等. 兒童肝移植術后耐碳青霉烯類腸桿菌科感染臨床特點分析. 中華兒科雜志, 2020, 58(8): 640-645.

West China Medical Journal

Predictors for carbapenem-resistant bacteria as the pathogens of bloodstream infections

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