Carbapenem-resistant Gram-negative bacteria (CR-GNB) in ICUs: resistance genes, therapeutics, and prevention – a comprehensive review

Li, Qi; Zhou, Xiaoshi; Yang, Rou; Shen, Xiaoyan; Li, Guolin; Zhang, Changji; Li, Pengfei; Li, Shiran; Xie, Jingxian; Yang, Yong

doi:10.3389/fpubh.2024.1376513

Cited by 3 publications

References 127 publications

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External validation of the ICU-CARB score to predict carbapenem-resistant gram-negative bacteria carriage in critically ill patients upon ICU admission: a multicenter analysis

Wu,

Wang,

Shen

et al. 2024

Antimicrob Resist Infect Control

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Background Recognition of carbapenem-resistant gram-negative bacteria (CR-GNB) carriage is frequently delayed, which increases the risk of subsequent infection and transmission. Previously, we developed a scoring system to identify CR-GNB carriage upon intensive care unit (ICU) admission. Although the ICU-CARB score showed satisfactory performance, it has not been externally validated. In this study, therefore, we externally validated the ICU-CARB score. Methods In the previous article, we introduced a risk-scoring system that incorporated seven key variables: neurological disease, high-risk department history, length of stay ≥ 14 days, ICU history, invasive mechanical ventilation, gastrointestinal tube placement, and carbapenem usage. To externally validate the ICU-CARB score, we conducted a study involving patients admitted to the ICUs of four tertiary hospitals between January 2021 and December 2023. Patients from three hospitals were grouped into Cohort I ( n = 815) and those from the fourth hospital into Cohort II ( n = 1602). Model calibration, discrimination, and performance were then assessed. Results A total of 2417 patients were included, among which 289 (12%) carried CR-GNB upon ICU admission. Neurological disease, high-risk department history and length of stay ≥ 14 days were still 3 most important contributing factors in the scoring system. The ICU-CARB score exhibited high calibration, with an area under the receiver operating characteristic curve of 0.825 (95% confidence interval [CI], 0.778–0.873) for Cohort I and 0.823 (95% CI, 0.791–0.855) for Cohort II. The ICU-CARB score showed a highly positive association with CR-GNB carriage in both cohort I (C = 0.315; P < 0.001) and Cohort II (C = 0.381; P < 0.001). Conclusions Despite differences in patient population characteristics, the ICU-CARB score for CR-GNB carriage upon ICU admission exhibited good discrimination in external validation, supporting its potential generalizability to other ICU settings. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-024-01509-y.

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External validation of the ICU-CARB score to predict carbapenem-resistant gram-negative bacteria carriage in critically ill patients upon ICU admission: a multicenter analysis

Wu,

Wang,

Shen

et al. 2024

Antimicrob Resist Infect Control

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Clinical outcomes and nephrotoxicity of colistin methanesulfonate in critically ill patients with carbapenem-resistant organisms infections: a retrospective study

Ren,

Xu,

Zhou

et al. 2024

Preprint

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Background Carbapenem resistant organisms (CRO) infection is one of the most common causes of high mortality among critically ill patients. Colistin methanesulfonate (CMS) represents a significant treatment option for CRO infections, yet the available data on CMS in the Chinese population remains limited. This study aimed to analyze the clinical outcomes and nephrotoxicity of CMS in treating critically ill patients with CRO infections in China. Methods A retrospective study was conducted from June 2022 to September 2023 in critically ill patients with CRO infections who received CMS treatment. The clinical outcomes were assessed by clinical effective, microbiological eradication, infection-related hospital mortality, the length of ICU stay, and total hospital stay. A sub-group analysis was conducted on patients with lung infection. The nephrotoxicity was assessed by the acute kidney injury (AKI). Results A total of 96 critically ill patients with CRO infections were enrolled in the study. The overall clinical effective, microbiological eradication and infection-related hospital mortality rates were 67.90%, 60.49% and 8.33%, respectively. The median length of ICU and total hospital stays was 28 and 32.5 days, respectively. In patients with lung infection, 70.31% and 61.19% achieved clinical effective and microbiological eradication, respectively. The younger patients (< 65 years old), patients who received intravenous combined nebulized CMS, and infections caused by CRE benefitted more from CMS treatment. The incidence of acute kidney injury (AKI) was 28 cases (30.43%), with the majority (82.14%) occurring in stage 1. Conclusions CMS treatment in Chinese critically ill patients with CRO infections achieved favorable outcomes, with acceptable nephrotoxicity, providing a promising option for this fatal disease.

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Risk Factors Analysis and Prediction Model Establishment for Carbapenem-Resistant Enterobacteriaceae Colonization: A Retrospective Cohort Study

Guo,

Wu,

Chen

et al. 2024

IDR

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Carbapenem-resistant Gram-negative bacteria (CR-GNB) in ICUs: resistance genes, therapeutics, and prevention – a comprehensive review

Cited by 3 publications

References 127 publications

External validation of the ICU-CARB score to predict carbapenem-resistant gram-negative bacteria carriage in critically ill patients upon ICU admission: a multicenter analysis

External validation of the ICU-CARB score to predict carbapenem-resistant gram-negative bacteria carriage in critically ill patients upon ICU admission: a multicenter analysis

Clinical outcomes and nephrotoxicity of colistin methanesulfonate in critically ill patients with carbapenem-resistant organisms infections: a retrospective study

Risk Factors Analysis and Prediction Model Establishment for Carbapenem-Resistant Enterobacteriaceae Colonization: A Retrospective Cohort Study

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