Objective To study the risk factors and prognosis of hospital acquired pneumonia( HAP)caused by carbapenem-resistant Acinetobacter baumannii( CRAB) . Methods By a case-control study, the data of 44 cases of HAP caused by CRAB fromJan 2005 to Dec 2007 in Nanfang Hospital were analyzed. 66 cases of HAP caused by Carbapenem-susceptible A. baumannii ( CSAB) were selected randomly at the same time as control. Univariate analysis( T test and chi-square test) and multivariate logistic regression were used for statistics analysis. Results Univariate analysis revealed that five factors associated with the infection caused by CRAB were APACHE Ⅱ score ≥ 16, chronic pulmonary disease ( COPD/ bronchiectasis ) , imipenem/meropenem and fluoroquinolone used 15 days before isolation of CRAB, and early combination therapy of antibiotics. Multivariate logistic regression analysis identified two independent factors as APACHEⅡ score ≥16( OR=6. 41, 95% CI 2. 20-18. 67) and imipenem/meropenemused 15 days before isolation of CRAB( OR =6. 33,95% CI 1. 83-21. 87) . Of 44 cases of CRAB infections, 14 patients died and 30 patients survived. Univariate analysis revealed that two factors associated with poor prognosis were organ failure and clinical pulmonary infection score( CPIS) rise after three-day treatment. According to multivariate logistic regression analysis, only CPIS rise after three-day treatment ( OR =7. 01, 95% CI 1. 23-40. 03) was an independent predictive factor. Conclusions APACHEⅡ score ≥ 16 and imipenem/meropenem used 15 days before isolation of CRAB were independent risk factors for CRAB infection. CPIS rise after three-day treatment was a predictive factor for the prognosis of CRAB infection.
There is a worldwide consensus that urgent action is needed to prevent and control multi-drug resistant organisms in health care settings, especially carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPsA). In 2017, to focus on this topic, World Health Organization organized experts worldwide to develop guidelines for the prevention and control of CRE, CRPsA and CRAB. In this paper, we introduced the background, development process, main measures, advantages and disadvantages of the guidelines to help infection prevention and control practitioners take actions properly based on the guidelines.
ObjectivesTo identify the clinical characteristics and prognosis for CRKP (Carbapenem-resistant Klebsiella pneumonia, CRKP) infection among ICU patients in the Second Affiliated Hospital of Anhui Medical University. MethodsWe conducted a retrospectively analysis in which 19 patients infected by CRKP with another 21 CSKP (Carbapenem-sensitive Klebsiella pneumoniae, CSKP) infected patients from January 2017 to April 2018. Risk factors for CRKP infection were assessed. ResultsThe lower respiratory tract is the most common site of CRKP infection in our department. CRKP infection was associated with several clinical symptoms, particularly a higher incidence of sepsis shock (χ2=8.338, P=0.004), more application of the combined medicine (χ2=26.3, P<0.001), prolonged hospital stays (χ2=–2.217, P=0.027) and more expenses on antibiotics (χ2=12.855, P=0.005), and the declined survival rates in 14 days (χ2=4.269, P=0.039) and 21 days (χ2 =5.647, P=0.017). The resistance rate of CRKP strains was high, however no resistance to tegafycline was found. The risk factors of CRKP infection included three generations of cephalosporin and/or hydrocarbonase antibiotics exposure (χ2 =6.388, P=0.041), exposure time of three generations of cephalosporin (U=–2.187, P=0.029), exposure time of hydrocarbonase antibiotics (U=–2.103, P=0.035), tracheal intubation (χ2=6.352, P=0.012), tracheotomy (χ2 =4.821, P=0.028), SOFA score (t=4.505, P<0.001) and Charlson comorbidity index (t=3.041, P=0.004). The SOFA score was the only factor independently associated with CRKP bacteremia (P=0.02). ConclusionsCRKP infections in ICU directly affect the course of disease, survival time and treatment expenses of patients. Therefore, monitoring bacterial resistance, rational use of antibiotics, and protection of the immune function are of great significance for prevention and treatment of CRKP infection.
ObjectiveTo understand the distribution characteristics and nosocomial infection of carbapenem-resistant Enterobacteriaceae (CRE) in a general hospital of traditional Chinese medicine, so as to provide the evidence for control and management of multidrug-resistant bacteria.MethodsData of CRE in the first Affiliated Hospital of Anhui University of Traditional Chinese Medicine were analyzed retrospectively from 2014 to 2018.ResultsThe total detection rate of CRE was 10.76%, 5.58%, 15.42%, 12.94% and 16.18% from 2014 to 2018, respectively. The detection rate of CRE showed a gradual upward trend (χ2=29.940, P<0.001). The highest number of CRE isolated from clinical specimens was sputum (355 strains, 63.39%), and the next were urine (98 strains, 17.50%) and secretions (38 strains, 6.79%). CRE isolated from different clinical departments were mainly in Neurosurgery Department (172 stains, 30.71%), Intensive Care Unit (Internal Medicine) (145 strains, 25.89%), Intensive Care Unit (Surgery)(106 strains,18.93%), and other internal medical departments (83 strains, 14.82%). A total of 179 patients developed CRE nosocomial infection in the past 5 years, who were mainly male, and with advanced age, long hospital stay, basic diseases, abnormal immune function and invasive operation. The incidence of hospital infection with CRE from 2014 to 2018 were 0.31‰, 0.38‰, 0.89‰, 0.80‰ and 1.14‰, respectively, which also showed a gradual upward trend (χ2=25.111, P<0.001).ConclusionWith the increasing number of clinically isolated CRE strains and the increasing incidence of nosocomial infection of CRE, effective intervention measures should be taken to prevent and control CRE.
ObjectivesTo systematically review the risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect cohort or case-control studies on the risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates from inception to May 2020. Two reviewers independently screened literature, extracted data, and assessed risk of bias of included studies, and meta-analysis was performed by RevMan5.3 software.ResultsA total of 9 case-control studies involving 759 patients were included. The results of meta-analysis showed that, maternal factors like placental abruption (OR=6.25, 95%CI 1.47 to 26.61, P=0.01), premature rupture of fetal membranes of parturient (OR=5.62, 95%CI 2.63 to 12.00, P<0.000 01), pregnancy-induced hypertension (OR=2.04, 95%CI 1.49 to 2.80, P<0.000 01), carbapenem antibiotics used in mothers (OR=1.77, 95%CI 1.10 to 2.81, P=0.017), neonatal factors like premature delivery (OR=1.96, 95%CI 1.06 to 3.61, P=0.03), mechanical ventilation (OR=2.14, 95%CI 1.01 to 4.55, P=0.05), surgical procedure (OR=14.17, 95%CI 2.46 to 81.70, P=0.003), umbilical vein catheter (OR=1.93, 95%CI 1.20 to 3.11, P=0.007), peripherally inserted central catheter (OR=4.30, 95%CI 1.86 to 9.93, P=0.000 6), nasogastric feeding (OR=4.37, 95%CI 1.44 to 13.29, P=0.009), use of carbapenems (OR=3.04, 95%CI 1.91 to 4.84, P<0.000 01), and admission to NICU (OR=2.78, 95%CI 1.79 to 4.33, P<0.000 01) were the risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates. Breastfeeding (OR=0.30, 95%CI 0.13 to 0.70, P=0.005) was the protective factor of carbapenem-resistant enterobacteriaceae colonization or infection in neonates.ConclusionsThe current evidence shows that maternal factors like placental abruption, premature rupture of fetal membranes, pregnancy-induced hypertension, carbapenem antibiotics used in mothers, and neonatal factors like premature delivery, mechanical ventilation, surgical procedure, umbilical vein catheter, peripherally inserted central catheter, nasogastric feeding, use of carbapenems, and admission to NICU are the risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates; while breastfeeding is the protective factor of carbapenem-resistant enterobacteriaceae colonization or infection in neonates. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the conclusions.
ObjectiveTo study the direct economic burden of hospitalization in patients with carbapenem-resistant Enterobacteriaceae (CRE) infection.MethodsPatients with CRE detected in Jianyang People’s Hospital between January 2017 and June 2019 were divided into infection group and colonization group, and multiple linear regression analysis was used to analyze the confounding factors, and then propensity score matching method was used to match the confounding factors of the two groups, finally the direct economic burden of hospitalization was compared between the two groups.ResultsA total of 2 013 patients were enrolled, including 507 CRE-infected patients and 1 506 CRE-colonized patients. Multiple linear regression results showed that factors affecting the direct economic burden of hospitalization included mechanical ventilation, intravenous catheterization, blood transfusion or use of blood products, urinary intubation, tracheotomy, gender, surgery, intensive care unit stay, main diagnosis, and the type of medical insurance, together with CRE infection (P<0.05). After propensity score matching, these confounding factors were well balanced between the infection group (n=249) and the colonization group (n=249), and the differences were not statistically significant (P>0.05). The median of total hospitalization cost of CRE-infected patients was 1.29 times (15 589.23 yuan more than) that of CRE-colonized patients and the difference between the two groups was statistically significant (Z=–3.116, P=0.002). The top two types of hospitalization cost with largest differences in the medians were the cost of Western medicine (4 850.21 yuan; Z=–3.460, P=0.001) and the cost of laboratory diagnosis (2 613.00 yuan; Z=–3.529, P<0.001), respectively. The cost of antimicrobial drugs differed significantly between the two groups (Z=–3.391, P=0.001), and it was 1.54 times in patients with CRE infection what it was in patients with CRE colonization.ConclusionsThere are many factors affecting the direct economic burden of inpatients, and it is necessary to avoid the influence of confounding factors as far as possible during analysis. The economic burden of patients with CRE infection is significantly greater than that of CRE-colonized patients, so active measures should be adopted to prevent and control CRE infection.
ObjectiveTo evaluate the burden of carbapenem-resistant Klebsiella pneumoniae (CRKPN) and carbapenem-resistant Escherichia coli (CRECO), two types of carbapenem-resistant Enterobacteriaceae (CRE), in pediatric patients in Jiangxi Province.MethodsA retrospective investigation was carried out for the distribution of CRKPN/CRECO in pediatric (neonatal group and non-neonatal group) and adult patients in 30 hospitals in Jiangxi Province from January 2016 to December 2018, and the changing trends and detection situations of different patients and types of hospitals were compared and analyzed.ResultsFrom 2016 to 2018, the annual resistance rates of Klebsiella pneumoniae and Escherichia coli to carbapenem in pediatric patients were 5.89%, 4.03%, and 4.24%, respectively, showed a downward trend (χ2trend=5.568, P=0.018). The resistance rate of Klebsiellae pneumoniae and Escherichia coli to carbapenem in neonatal group was higher than that in non-neonatal group (8.44% vs. 3.40%; χ2=63.155, P<0.001) and adult group (8.44% vs. 3.45%; χ2=97.633, P<0.001). In pediatric patients, the 3-year carbapenem resistance rate of Klebsiella pneumoniae was higher than that of Escherichia coli (9.10% vs. 2.48%; χ2=128.177, P<0.001). In non-neonatal pediatric patients, the 3-year resistance rate of Klebsiella pneumoniae and Escherichia coli to carbapenem in maternity and children hospitals was higher than that in general hospitals (4.35% vs. 1.36%; χ2=25.930, P<0.001). CRKPN/CRECO detected in pediatrics were mainly isolated from sputum (31.64%), blood (24.36%), urine (13.82%), and pus (8.36%).ConclusionAlthough the overall resistance rate of Klebsiella pneumoniae and Escherichia coli to carbapenem in pediatric patients showed a downward trend, that in neonatal patients was still high, and the monitoring and prevention and control measures of CRE should be strengthened in neonatal patients.
ObjectivesTo detect the admission rate and hospital acquired rate of carbapenem-resistant Klebsiella pneumoniae (CRKP) and carbapenem-resistant Acinetobacter baumannii (CRAB) of active surveillance in Emergency Intensive Care Unit patients of West China Hospital of Sichuan University, to examine whether rectal colonization of CRKP and CRAB are associated with nosocomial infection, so as to provide a scientific basis for the prevention and control of CRKP and CRAB.MethodsA nested case-control study was conducted between April and September 2018 in Emergency Intensive Care Unit. Rectal swabs were obtained to screen CRAB and CRKP, and the admission rate of colonization was calculated. According to whether infected with CRKP/CRAB, the patients were divided into case group (infection group) and control group (noninfection group) to determine whether colonization of CRKP/CRAB were independent risk factors for nosocomial infection using logistic regression model.ResultsThe admission rate of CRKP and CRAB patients were 4.08% (18/441) and 8.78% (38/433), and the nosocomial infection rate was 3.63% (16/441) and 18.01% (78/433) separately. Multivariate analysis showed that rectal colonization of CRKP [odds ratio=5.438, 95% confidence interval (1.643, 17.999), P=0.006] was an independent risk factor for nosocomial infection. However, there was no statistical correlation between rectal colonization of CRAB and nosocomial infection [odds ratio=1.449, 95% confidence interval (0.714, 2.942), P=0.305].ConclusionsThe rectal colonization rate of CRAB is higher than that of CRKP, but it does not increase the risk of CRAB infection in patients. Rectal colonization of CRKP is an important factor for infection of patients. Therefore, early detection of CRKP through active surveillance and taking control measures can help reduce the risk of its spread in the hospital.
Objective To explore the overall outcome and its factors of patients with carbapenem-resistant Pseudomonas aeruginosa bloodstream infection (CRPA-BSI). Methods A single-center, retrospective cohort study was carried out. The demographic and clinical data of all emergency patients and inpatients in West China Hospital of Sichuan University from 2017 to 2021 were collected. Firstly, the prognosis of patients with CRPA-BSI was compared with those with carbapenem-sensitive Pseudomonas aeruginosa bloodstream infection (CSPA-BSI). Then Cox regression was used to analyze the factors affecting the prognosis of CRPA-BSI patients. Results A total of 53 patients with CRPA-BSI and 175 patients with CSPA-BSI were enrolled, and they were 1∶1 matched according to the age-adjusted Charlson Comorbidity Index (aCCI) to control for confounding factors. When aCCI was similar, the incidence of poor prognosis in CRPA-BSI patients was significantly higher than that in CSPA-BSI patients [41.5% vs. 18.9%; relative risk=2.20, 95% confidence interval (CI) (1.16, 4.19), P=0.011]. The median length of hospital stay in the CRPA-BSI group was 3 d longer than that in the CSPA-BSI group but the difference was not statistically significant (29 vs. 26 d, P=0.388). With regard to prognostic factors, univariate Cox regression analyses showed that the highest temperature ≤39℃ (P=0.014), hepatobiliary and pancreatic diseases (P=0.011), days of central venous catheterization (P=0.025), days of indwelling urinary catheters (P=0.037), adjustment of medication duration according to drug sensitivity results (P=0.015) and Pitt bacteremia score (P=0.007) were related to the poor prognosis of CRPA-BSI patients. Multiple Cox regression analysis showed that hepatobiliary and pancreatic disease [hazard ratio (HR)=3.434, 95%CI (1.271, 9.276), P=0.015] and Pitt bacteremia score [HR=1.264, 95%CI (1.057, 1.510), P=0.010] were independently associated with poor outcome in CRPA-BSI patients. Conclusions The prognosis of CRPA-BSI patients is worsen than that of CSPA-BSI patients. Hepatobiliary and pancreatic diseases significantly increase the risk of poor outcome in CRPA-BSI patients. Pitt bacteremia score is a predictor of prognosis in patients with CRPA-BSI.
Objective To analyze the clinical characteristics, mortality risk and risk factors of patients with carbapenem resistant Acinetobacter baumannii (CRAB), so as to provide references for the prevention and control of CRAB. Methods Inpatients with Acinetobacter baumannii were selected from the clinical samples in the intensive care unit of Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital between January 2018 and December 2021. The patients were divided into CRAB infection group, carbapenem-sensitive Acinetobacter baumannii (CSAB) infection group and CRAB colonization group. Survival analysis was used to analyze the mortality risk and its influencing factors in patients with CRAB infection. Results A total of 696 patients were included. Among them, there were 392 cases of CRAB infection, 267 cases of CRAB colonization, and 37 cases of CSAB infection. The factors that increased the 30-day mortality risk of CRAB mainly included blood transfusion or use of blood products, mechanical ventilation, respiratory failure, maximum procalcitonin and age. Kaplan-Meier analysis showed that the 30-day mortality risk of CRAB infection group was higher than that of CSAB infection group（χ2=4.837, P=0.028), there was no significant difference between CRAB infection group and CRAB colonization group in 30-day mortality risk（χ2=0.219, P=0.640). Conclusions The mortality risk of CRAB infected patients is higher. Compared with the infection status, the 30-day mortality risk of patients is more attributed to drug resistance status. The effective method to control the mortality rate of CRAB should focus on reducing the hospital acquisition rate of CRAB.