Risk Factors and Molecular Epidemiology of Complicated Intra-Abdominal Infections With Carbapenem-Resistant Enterobacteriaceae: A Multicenter Study in China

Jiao Liu; Lidi Zhang; Jingye Pan; Man Huang; Yingchuan Li; Hongjin Zhang; Ruilan Wang; Mingyan Zhao; Bin Li; Long Liu; Ye Gong; Jinjun Bian; Xiang Li; Yan Tang; Ming Lei; Dechang Chen

doi:10.1093/infdis/jiz574

Risk Factors and Molecular Epidemiology of Complicated Intra-Abdominal Infections With Carbapenem-Resistant Enterobacteriaceae: A Multicenter Study in China

J Infect Dis. 2020 Mar 16;221(Suppl 2):S156-S163. doi: 10.1093/infdis/jiz574.

Authors

Jiao Liu¹, Lidi Zhang¹, Jingye Pan², Man Huang³, Yingchuan Li⁴, Hongjin Zhang⁵, Ruilan Wang⁶, Mingyan Zhao⁷, Bin Li⁸, Long Liu⁹, Ye Gong¹⁰, Jinjun Bian¹¹, Xiang Li¹², Yan Tang¹³, Ming Lei¹⁴, Dechang Chen¹

Affiliations

¹ Department of Critical Care Medicine, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Department of Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical School, Wenzhou, Zhejiang, China.
³ Department of Critical Care Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
⁴ Department of Critical Care Medicine, Shanghai the Sixth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
⁵ Department of Critical Care Medicine, Dongyang People's Hospital, Dongyang, Zhejiang, China.
⁶ Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
⁷ Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjing, China.
⁸ Department of Critical Care Medicine, the First Hospital of Lanzhou University, Lanzhou, Gansu, China.
⁹ Intensive Care Unit, The First People's Hospital of Kunshan, Kunshan, Jiangsu, China.
¹⁰ Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China.
¹¹ Department of Critical Care Medicine, Changhai Hospital, Naval Military Medical University, Shanghai, China.
¹² Department of Critical Care Medicine, Minhang Hospital, Fudan University, Shanghai, China.
¹³ Department of Critical Care Medicine, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China.
¹⁴ Department of Critical Care Medicine, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China.

PMID: 32176797
DOI: 10.1093/infdis/jiz574

Abstract

Background: Carbapenem-resistant Enterobacteriaceae (CRE) infections are associated with poor patient outcomes. Data on risk factors and molecular epidemiology of CRE in complicated intra-abdominal infections (cIAI) in China are limited. This study examined the risk factors of cIAI with CRE and the associated mortality based on carbapenem resistance mechanisms.

Methods: In this retrospective analysis, we identified 1024 cIAI patients hospitalized from January 1, 2013 to October 31, 2018 in 14 intensive care units in China. Thirty CRE isolates were genotyped to identify β-lactamase-encoding genes.

Results: Escherichia coli (34.5%) and Klebsiella pneumoniae (21.2%) were the leading pathogens. Patients with hospital-acquired cIAI had a lower rate of E coli (26.0% vs 49.1%; P < .001) and higher rate of carbapenem-resistant Gram-negative bacteria (31.7% vs 18.8%; P = .002) than those with community-acquired cIAI. Of the isolates, 16.0% and 23.4% of Enterobacteriaceae and K pneumoniae, respectively, were resistant to carbapenem. Most carbapenemase-producing (CP)-CRE isolates carried blaKPC (80.9%), followed by blaNMD (19.1%). The 28-day mortality was 31.1% and 9.0% in patients with CRE vs non-CRE (P < .001). In-hospital mortality was 4.7-fold higher for CP-CRE vs non-CP-CRE infection (P = .049). Carbapenem-containing combinations did not significantly influence in-hospital mortality of CP and non-CP-CRE. The risk factors for 28-day mortality in CRE-cIAI included septic shock, antibiotic exposure during the preceding 30 days, and comorbidities.

Conclusions: Klebsiella pneumoniae had the highest prevalence in CRE. Infection with CRE, especially CP-CRE, was associated with increased mortality in cIAI.

Keywords: carbapenem-resistant Enterobacteriaceae (CRE); carbapenemase-producing Enterobacteriaceae (CP-CRE); complicated intra-abdominal infection (cIAI); epidemiology; risk factors.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Anti-Bacterial Agents / pharmacology*
Bacterial Proteins / genetics
Carbapenem-Resistant Enterobacteriaceae / drug effects
Carbapenem-Resistant Enterobacteriaceae / pathogenicity*
China / epidemiology
Cross Infection / drug therapy
Cross Infection / epidemiology
Enterobacteriaceae Infections / drug therapy*
Enterobacteriaceae Infections / microbiology
Enterobacteriaceae Infections / mortality
Escherichia coli / pathogenicity
Female
Gram-Negative Bacteria
Hospital Mortality
Humans
Intraabdominal Infections / drug therapy*
Intraabdominal Infections / microbiology
Intraabdominal Infections / mortality
Klebsiella pneumoniae / drug effects
Klebsiella pneumoniae / pathogenicity*
Logistic Models
Male
Middle Aged
Molecular Epidemiology*
Multivariate Analysis
Retrospective Studies
Risk Factors
beta-Lactamases / genetics

Substances

Anti-Bacterial Agents
Bacterial Proteins
beta-Lactamases