A Retrospective Study of Risk Factors, Mortality, and Treatment Outcomes for Infections with Carbapenemase-Producing Enterobacterales in a Tertiary Hospital in Havana, Cuba

Abstract

(1) Background: The spread of carbapenem-resistant Enterobacterales in hospitals constitutes an important epidemiological and therapeutic problem that especially affects vulnerable patients such as perioperative patients. (2) Methods: We conducted a descriptive, observational, retrospective case-control study of patients infected with carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) and carbapenem-susceptible Enterobacterales during the perioperative period in a tertiary hospital. (3) Results: Metallo-β-lactamase was detected in all 124 CRE isolates, with NDM-type carbapenemase being dominant, while 3 isolates coproduced KPC-type enzyme and showed high resistance rates against all antibiotics except colistin (25.2%). By analyzing the risk factors for infection, steroid use (OR: 3.22, p < 0.01), prior use of two or more antibiotics (OR: 4.04, p = 0.01), prior use of broad-spectrum cephalosporins (OR: 2.40, p = 0.04), and prior use of carbapenem (OR: 4.77, p = 0.03) were found to be independent risk factors for CP-CRE infection. In addition, in this study, we observed that the clinical outcomes of bloodstream infections and pneumonia associated with CP-CRE posed higher mortality risks. However, by analyzing the associations between treatment options and mortality, it was found that, in bloodstream infections caused by CP-CRE, colistin-based regimens showed a significant advantage (PR = 0.40, p = 0.03). (4) Conclusions: High mortality is associated with nosocomial infections in the perioperative period caused by carbapenemase-producing Enterobacterales, the dissemination of which in health care settings in Cuba remains a public health challenge.

Carbapenem resistant Enterobacterales in the United Arab Emirates: a retrospective analysis from 2010 to 2021

“…Patients associated with CRE were four-fold more likely to be admitted to ICU, and their median length of stay was increased by 10 days, as compared to patients associated with non-CRE. This is consistent with other findings that indicated high mortality rate and poor outcomes in patients with CRE (43,44), and highlights need for surveillance and control for better health outcomes.…”

ESKAPE and Beyond: The Burden of Coinfections in the COVID-19 Pandemic

“…According to the global surveillance of Enterobacterales conducted by SENTRY, CRE infections have shown a significant increase worldwide, with a greater impact in Latin America (rates increased from 0.8% in 1997 to 6.4% in 2016). The most prevalent CRE infections among hospitalised patients are pneumonia (3.3%) and bloodstream infection (2.5%), while the prevalence of skin and soft tissue infection and urinary tract infection is 1.8% and 1.2%, respectively [ 71 ].…”