Guidelines for the diagnosis, treatment, prevention and control of infections caused by carbapenem-resistant gram-negative bacilli

Zeng, Mei; Xia, Jun; Zong, Zhiyong; Shi, Yi; Ni, Yuxing; Hu, Fupin; Chen, Yijian; Zhuo, Chao; Hu, Bijie; Lv, Xiaoju; Li, Jiabin; Liu, Zhengyin; Zhang, Jing; Yang, Wenjie; Yang, Fan; Yang, Qiwen; Zhou, Hua; Li, Xin; Wang, Jianhua; Li, Yimin; Ren, Jianan; Chen, Baiyi; Chen, Dechang; Wu, Anhua; Guan, Xiangdong; Qu, Jieming; Wu, Depei; Huang, Xiao‐Jun; Qiu, Haibo; Xu, Yingchun; Yu, Yunsong; Wang, Minggui

doi:10.1016/j.jmii.2023.01.017

Cited by 48 publications

(21 citation statements)

References 95 publications

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“…Controlling the spread of CRE has become a critical public health concern on a global scale, necessitating the implementation of infection prevention and control measures (Magiorakos et al, 2017;Zeng et al, 2023). Intensive Care Unit (ICU) admission and hematological malignancies are identified as risk factors associated with CRE infection (Tian et al, 2016;Chen et al, 2022; Zhang Other Enterobacterales 0 (0.0) 2 (6.1) 1.000 * Significant statistical difference (P < 0.05).…”

Section: Discussionmentioning

confidence: 99%

Risk factors of Carbapenem-resistant Enterobacterales intestinal colonization for subsequent infections in hematological patients: a retrospective case-control study

Wang,

Shao,

Shao

et al. 2024

Front. Microbiol.

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ObjectiveInfections caused by Carbapenem-resistant Enterobacterales (CRE) have high treatment costs, high mortality and few effective therapeutic agents. This study aimed to determine the risk factors for progression from intestinal colonization to infection in hematological patients and the risk factors for 30-day mortality in infected patients.MethodsA retrospective case-control study was conducted in the Department of Hematology at Shandong Provincial Hospital affiliated to Shandong First Medical University from April 2018 to April 2022. Patients who developed subsequent infections were identified as the case group by electronic medical record query of patients with a positive rectal screen for CRE colonization, and patients who did not develop subsequent infections were identified as the control group by stratified random sampling. Univariate analysis and logistic regression analysis determined risk factors for developing CRE infection and risk factors for mortality in CRE-infected patients.ResultsEleven hematological patients in the study developed subsequent infections. The overall 30-day mortality rate for the 44 hematological patients in the case-control study was 11.4% (5/44). Mortality was higher in the case group than in the control group (36.5 vs. 3.0%, P = 0.0026), and septic shock was an independent risk factor for death (P = 0.024). Univariate analysis showed that risk factors for developing infections were non-steroidal immunosuppressants, serum albumin levels, and days of hospitalization. In multivariable logistic regression analysis, immunosuppressants [odds ratio (OR), 19.132; 95% confidence interval (CI), 1.349–271.420; P = 0.029] and serum albumin levels (OR, 0.817; 95% CI, 0.668–0.999; P = 0.049) were independent risk factors for developing infections.ConclusionOur findings suggest that septic shock increases mortality in CRE-infected hematological patients. Hematological patients with CRE colonization using immunosuppressive agents and reduced serum albumin are more likely to progress to CRE infection. This study may help clinicians prevent the onset of infection early and take measures to reduce mortality rates.

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Section: Discussionmentioning

confidence: 99%

Risk factors of Carbapenem-resistant Enterobacterales intestinal colonization for subsequent infections in hematological patients: a retrospective case-control study

Wang,

Shao,

Shao

et al. 2024

Front. Microbiol.

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“…In this study, the isolation rates of MDROs, XDROs and PDROs were high, accounting for 36.9%, 16.3% and 5.0%, respectively, among which carbapenem-resistant gramnegative bacteria (CR-GNB) accounted for 35.5%. The prevalence and spread of CR-GNB is a global public health problem, and the isolated strains are often MDR or XDR, resulting in limited antimicrobial treatment options and high mortality [20]. In 2017, the World Health Organization (WHO) listed CRE, CRAB and CRPA as serious threat level pathogens in the global priority list of antibiotic-resistant bacteria.…”

Section: Discussionmentioning

confidence: 99%

“…Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa are the main pathogens causing drug resistance-related deaths, which can lead to more than 50,000 deaths due to antibiotic resistance every year [20,21]. Therefore, for AAD patients undergoing complex vascular replacement surgery, NI, especially infection with MDR or XDR pathogens, will seriously affect the clinical outcome and outcomes of hospitalized patients, reduce the success rate of treatment, and bring about a substantial increase in medical costs and excessive consumption of medical resources.…”

Section: Discussionmentioning

confidence: 99%

Clinical Presentation, Aetiological Characteristics, Risk Factors and In-hospital Outcome of Nosocomial Infection following Acute Aortic Dissection Surgery in Adult Patients

Ren,

Xin,

Zhang

et al. 2023

Preprint

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Background Nosocomial infection (NI) is one of the most common complications after acute aortic dissection surgery (AADS) and contributes significantly to mortality and length of hospital stay. Therefore, this study analysed the clinical characteristics of NI and determined the risk factors for the occurrence and development of NI and in-hospital outcomes. Methods During this study, 429 adult patients with AADS were divided into an infected group (n = 141) and a noninfected group (n = 288). Complete clinical data (including baseline clinical characteristics and laboratory results, surgery-related variables, and clinical outcomes) were collected for statistical analysis. Multivariate logistic regression was used to determine the independent risk factors for the occurrence of NI after AADS. Results The incidence of NI in AADS was 29.0%. The main clinical presentations were hospital-acquired pneumonia (HAP = 51.8%), ventilator-associated pneumonia (VAP = 24.8%) and bloodstream infection (BSI = 18.4%). The most common pathogenic bacteria were gram-negative bacilli (GNB = 68.8%), including Klebsiella pneumoniae (27.7%), Pseudomonas aeruginosa (16.3%) and Acinetobacter baumannii (13.5%). Multivariate regression analysis found that preexisting cerebrovascular disease, lower estimated glomerular filtration rate (eGFR), total protein and serum albumin, longer operation time and cardiopulmonary bypass (CPB) time, second operation in-hospital, exposure to extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT), and proton pump inhibitor (PPI) use were independent risk factors for the occurrence of NI (all P < 0.01). Compared with noninfected patients, the intensive care unit (ICU) stay time and total hospital stay time were significantly prolonged after the occurrence of NI (all P < 0.001). The risks of other complications, such as acute kidney injury (AKI), acute upper gastrointestinal haemorrhage, new cerebral infarction, paraplegia or hemiplegia, and new cerebral haemorrhage, were significantly higher in patients with NI after AADS than in noninfected patients (all P < 0.001). The in-hospital mortality (46.1%) of NI after AADS was significantly higher than that of noninfected patients (3.5%, P < 0.001). Conclusions This study identified the high morbidity and mortality of NI after AADS. The most frequent infection types were HAP, VAP and BSI, and the most common microorganisms isolated were Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii. Meanwhile, many risk factors affect the occurrence and development of NI. Hence, clinicians should be reminded to identify high-risk patients early and develop individualized perioperative prevention and management programs to reduce the morbidity and mortality of NI and improve the prognosis of patients with AAD.

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“…Carbapenemase production is the predominant resistance mechanism in Enterobacterales to carbapenems (8). Since various combinations of carbapenemase inhibitors exhibit different levels of inhibitory activity against different carbapenemases, this leads to divergent treatment regimens for infections caused by various drug-resistant bacteria (9).…”

Section: Discussionmentioning

confidence: 99%

Multicenter Antimicrobial Resistance Surveillance of Clinical Isolates from Major Hospitals — China, 2022

Guo,

Ding,

Yang

et al. 2023

China CDC Weekly

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What is already known about this topic?Bacterial resistance surveillance is crucial for monitoring and understanding the trends and spread of drug-resistant bacteria. What is added by this report?The number of strains collected in 2022 increased compared to 2021. The top five bacteria, including Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii, remained largely unchanged. The detection rate of methicillin-resistant strains continued to decrease. Among clinical Enterobacterales isolates, the resistance rate to carbapenems was generally below 13%, except for Klebsiella spp., which had a resistance range of 20.4% to 21.9%. Most clinical Enterobacterales isolates were highly susceptible to tigecycline, colistin, and polymyxin B, with resistance rates ranging from 0.1% to 12.6%. The detection rate of meropenem-resistant P. aeruginosa and meropenemresistant Acinetobacter baumannii showed a decreasing trend for the fourth consecutive year. What are the implications for public health practice? Multidrug-resistant bacteria remain a significant public health challenge in clinical antimicrobial treatment. To effectively address bacterial resistance, it is essential to enhance both bacterial resistance surveillance and the prudent use of antimicrobial agents.

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Guidelines for the diagnosis, treatment, prevention and control of infections caused by carbapenem-resistant gram-negative bacilli

Cited by 48 publications

References 95 publications

Risk factors of Carbapenem-resistant Enterobacterales intestinal colonization for subsequent infections in hematological patients: a retrospective case-control study

Risk factors of Carbapenem-resistant Enterobacterales intestinal colonization for subsequent infections in hematological patients: a retrospective case-control study

Clinical Presentation, Aetiological Characteristics, Risk Factors and In-hospital Outcome of Nosocomial Infection following Acute Aortic Dissection Surgery in Adult Patients

Multicenter Antimicrobial Resistance Surveillance of Clinical Isolates from Major Hospitals — China, 2022

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