Factors associated with mortality in Infections caused by Carbapenem-resistant Enterobacteriaceae

Abstract

Introduction: There is little information about weigh of factors possibly associated with mortality, in infections caused by Carbapenem-resistant Enterobacteriaceae (CRE) in Latin America.
 Methodology: A case-controls study nested in a historical cohort was performed including all patients with CRE infections diagnosed between June 2013 and December 2018 at Hospital Universitario San Ignacio in Bogotá, Colombia. Univariate and multivariate analysis were performed to compare cases of mortality within the first month after the infection diagnosis with surviving patients.
 Results: A total of 131 patients were included. The overall 30-day mortality rate was 38.17%. In the multivariate analysis, a direct association was found between mortality and septic shock (OR 26.7 CI6.6-107.3 p < 0.01), post-chemotherapy febrile neutropenia (OR 3.3 CI1.06–10.8 p = 0.04) and Charlson Index ≥ 3 (OR 5.5 CI 1.5-20.06 p < 0.01). An inverse association was found with interventions to control the infectious focus (OR 0.3 CI0.1-0.7 p < 0.01). The MIC of different antibiotics and the use of combined antibiotic therapy (triple therapy vs. double therapy or monotherapy) were not associated with mortality.
 Conclusions: In patients with CRE infections, septic shock, a Charlson comorbidity index ≥ 3, and post-chemotherapy febrile neutropenia are independently related to an increase in mortality. The control of the infectious focus is a protective factor. A rapid identification of these patients, and the implementation of measures to control infectious focus and to detect CRE colonization in patients who are going to be taken to myelosuppressive chemotherapy could impact positively the prognosis of these patients.

High Acquisition Rate of Gram-Negative Multi-Drug Resistant Organism Colonization During Hospitalization: A Perspective from a High Endemic Setting

“…This finding prompts to update antimicrobial guideline to direct appropriate agents with the right regimen for individual clinical cases. 5 , 6 …”

“… 26 , 27 Therefore it is important to take an organism-specific approach in the participating hospital including active screening of these organisms on admission. 5 , 6 Concerningly A. baumannii was detected in polytrauma and bone and joints unit and patients admitting to these facilities should be prioritized for screening.…”

“… 3 , 4 Infections caused by Enterobacterales are often related with a high mortality, morbidity and delay in effective treatment. 5 , 6 Therefore developed countries have given much importance to the colonization of patients admitted to the hospital and established guidelines to screen drug-resistant organisms from rectal swab, groin, etc. depending on the species of the organism.…”

Bacterial Antibiotic Resistance: The Most Critical Pathogens

“…Carbapenem-resistant K. pneumoniae strains are the most clinically prominent carbapenem-resistant Enterobacteriaceae (CRE) [92]. Carbapenems often are the last line of defense against gram-negative persistent infections, therefore the increasing prevalence of carbapenemase-producing K. pneumoniae (KPC) strains harboring the carbapenemase encoding blaKPC-3 gene, is a major threat to public health [93,94].…”

Clinical practice guideline for screening of patients at risk of colonization by carbapenemase-producing Enterobacterales and the treatment of infections caused by these bacteria

“…[IC] del 95%, 2.35-4.89), en comparación a las infecciones producidas por microorganismos sensibles a carbapenémicos (12), datos que se han reproducido en nuestro medio (13,14).…”