| Literature DB >> 33257451 |
Sho Saito1,2,3, Kayoko Hayakawa4,2, Shinya Tsuzuki2,5, Masahiro Ishikane4,2, Maki Nagashima4, Kazuhisa Mezaki6, Yuko Sugiki7, Taichi Tajima2, Nobuaki Matsunaga2, Satoshi Ide4,3, Noriko Kinoshita4,2,3, Yoshiki Kusama2,3, Yumiko Fujitomo2, Takato Nakamoto4, Yuta Toda4, Mitsuo Kaku8, Eiichi N Kodama9, Norio Ohmagari4,2,3.
Abstract
IMP-type carbapenemase, found in various Gram-negative bacteria, has been increasingly detected worldwide. We aimed to study the outcomes and risk factors for acquisition of IMP-type carbapenemase-producing carbapenem-resistant Enterobacteriaceae (IMP-CRE), as this has not been evaluated in detail. We conducted a matched case-case-control study of patients from whom IMP-CRE isolates were obtained. All patients who tested positive for IMP-CRE were included; they were matched with patients with carbapenem-susceptible Enterobacteriaceae (CSE) and with controls at a ratio of 1:1:2. The risk factors for acquisition for the CRE and CSE groups and mortality rates, which were calculated using multivariate logistic regression models with weighting according to the inverse probability of propensity scores, were compared. In total, 192 patients (96 patients each in the CRE and CSE groups, with 130 Enterobacter cloacae isolates and 62 Klebsiella sp. isolates) were included. The IMP-11 type was present in 43 patients, IMP-1 in 33, and IMP-60 and IMP-66 in 1 each; 31 patients with CRE (32.3%) and 34 with CSE (35.4%) developed infections. Multivariate analysis identified the following independent risk factors: gastrostomy, history of intravenous therapy or hemodialysis, and previous exposure to broad-spectrum β-lactam antibiotics, including penicillin with β-lactamase inhibitors, cephalosporins, and carbapenems. In propensity score-adjusted analysis, mortality rates for the CRE and CSE groups were similar (15.0% and 19.5%, respectively). We found that IMP-CRE may not contribute to worsened clinical outcomes, compared to CSE, and gastrostomy, previous intravenous therapy, hemodialysis, and broad-spectrum antimicrobial exposure were identified as risk factors for CRE isolation. Fluoroquinolone and aminoglycosides are potentially useful antibiotics for IMP-CRE infections.Entities:
Keywords: Enterobacteriaceae; IMP; carbapenem resistance; clinical outcomes; propensity score
Mesh：
Substances：
Year: 2021 PMID： 33257451 PMCID： PMC8092526 DOI： 10.1128/AAC.01483-20
Source DB: PubMed Journal: Antimicrob Agents Chemother ISSN： 0066-4804 Impact factor: 5.191