The burden of carbapenem-resistant Enterobacterales infection in a large Thai tertiary care hospital

Abstract

Background: Carbapenem-resistant Enterobacterales (CRE) are resistant to several other classes of antimicrobials, reducing treatment options and increasing mortality. We studied the clinical characteristics and burden of hospitalized adult patients with CRE infections in a setting where treatment options are limited.Methods: A retrospective cohort study included adult inpatients between January 2015–December 2019 at Siriraj Hospital in Bangkok, Thailand. Clinical and microbiological data were reviewed.Results: Of 420 patients with CRE infections, the mean age was 65.00 ± 18.89 years, 192 (45.72%) were male, and 112 (26.90%) were critically ill. Three hundred and eighty (90.48%) had Klebsiella pneumoniae, and 40 (9.52%) had Escherichia coli infections. The mean APACHE II score was 14.27 ± 6.36. Nearly half had previous hospitalizations (48.81%), 41.2% received antimicrobials, and 88.1% had undergone medical procedures before the onset of infection. The median time of onset of CRE infection was 16 days after admission. Common sites of infection were bacteremia (53.90%) and pneumonia (45.47%). Most CRE-infected patients had septic shock (63.10%) and Gram-negative co-infections (62.85%). Colistin (29.95%) and non-colistin (12.91%) monotherapies, and colistin-based (44.78%) and non-colistin-based (12.36%) combination therapies were the best available antimicrobial therapies (BAAT). The median length of hospitalization was 31 days, and the median hospitalization cost was US$10,435. The in-hospital mortality rate was 68.33%. Septic shock [adjusted odds ratio (aOR) 10.73, 5.65–20.42, p <0 .001], coinfection (aOR 2.43, 1.32–4.47, p = 0.004), mechanical ventilation (aOR 2.33, 1.24–4.36, p = 0.009), and a high SOFA score at onset (aOR 1.18, 1.07–1.30, p <0 .001) were associated with mortality.Conclusion: CRE infection increases mortality, hospital stays, and healthcare costs. A colistin-based regimen was the BAAT in this study. Therefore, newer antimicrobial agents are urgently needed.

Antimicrobial Use and Carbapenem-Resistant Enterobacterales in Korea: A Nationwide Case-Control Study With Propensity Score Matching

“… 36 Patients with CRE infection have a complex etiology, long hospitalization, poor prognosis, and high mortality, posing great challenges for clinical treatment. 37 38 Moreover, the medical costs of patients with CRE were approximately three times higher than those of non-CRE patients, making CRE an economic burden worldwide.…”

Mortality factors and antibiotic options in carbapenem‐resistant Enterobacterales bloodstream infections: Insights from a high‐prevalence setting with co‐occurring NDM‐1 and OXA‐48

“… 23 Tangsawad et al. reported a notably high in‐hospital mortality rate of 68.33%, 24 potentially attributed to differing outcome definitions. While previous studies have explored risk factors influencing mortality in CRE‐BSI patients, 3 , 4 , 5 none have specifically assessed the co‐occurrence of carbapenemase genes.…”

“…[10][11][12][13] Our study revealed a 14-day mortality rate of 35.1% following the onset of CRE-BSI, consistent with rates observed in low-and middle-income countries, where the CRE-BSI mortality rate stood at 35%, with bla NDM-1 emerging as the predominant carbapenemase gene, followed by bla OXA-48 . 23 Tangsawad et al reported a notably high inhospital mortality rate of 68.33%, 24 potentially attributed to differing outcome definitions. While previous studies have explored risk factors influencing mortality in CRE-BSI patients, [3][4][5] none have specifically assessed the cooccurrence of carbapenemase genes.…”