Retrospective Analysis On Clinical Characteristics And Risk Factors For Carbapenem-Resistant Enterobacteriaceae Co-Production With Extended-Spectrum β-Lactamases Infection

ObjectiveTo review and analyze the clinical distribution and drug resistance of Carbapenem-resistant Enterobacteriaceae(CRE)in a certain hospital,and to determine the independent risk factors for CRE combined with extended-spectrumβ-lactamase(ESBL)production,in order to provide some theoretical basis for clinical anti-infective treatment.MethodsA total of 340 inpatients infected with CRE strains from January 2017 to December 2021 in a tertiary hospital in Guangzhou were retrospectively collected to analyze the clinical distribution characteristics and drug resistance of CRE strains.The patients were divided into CRE-ESBL group(131 cases)and CRE group(control group,209 cases)according to whether they were also co-producing ESBL.Clinical data of the patients,such as demographic characteristics,hospital events,acute and chronic diseases,and invasive treatments,were collected,and the risk factors of patients infected with CRE in combination with ESBL were analyzed using logistic regression.ResultsFrom January 2017 to December 2021,there were 340 patients with hospital-wide CRE infections,and the main bacteria isolated from the 340 CRE strains were Klebsiella pneumoniae,Escherichia coli,Enterobacter cloacae,Serratia marcescens,and Citrobacter freundii,accounting for 74.1%,14.1%,3.2%,2.9%,and1.5%,respectively.Over the past 5 years,the 340 CRE strains were resistant to methicillin/sulfamethoxazole,gentamicin,ciprofloxacin,and levofloxacin year by year,and 340 CRE strains were highly resistant to multiple antibiotics.After analysis,admission to ICU,indwelling gastric tube,indwelling urinary catheter,ventilator use,deep vein placement,surgery,chronic kidney disease,and acute cerebral infarction were statistically different between the CRE-ESBL group and CRE group,and logistic regression analysis of the above significant variables showed that indwelling urinary catheter,chronic kidney disease,acute cerebral infarction,cerebral hemorrhage,and systemic autoimmune disease were independent risk factors for CRE-ESBL infection.Conclusions1.The resistance rate of CRE increased year by year in the last 5 years,showing high resistance to imipenem,ciprofloxacin,aztreonam,cefepime,piperacillin/tazobactam,and stronger resistance to CRE-ESBL strains than CRE strains;2.Indwelling urinary catheterization,the presence of comorbidities such as chronic kidney disease,acute cerebral infarction,cerebral hemorrhage,and systemic autoimmune diseases are independent risk factors for the infection of CRE combined with ESBL-producing strains.Therefore,extra vigilance is required during clinical anti-infective therapy.