Mortality-related risk factors of carbapenem-resistant Enterobacteriaceae infection with focus on antimicrobial regimens optimization: a real-world retrospective study in China
Abstract Objectives To determine the mortality-related risk factors for carbapenem-resistant Enterobacteriaceae (CRE) infection in hospitalized patients and to compare the clinical efficacy of different antimicrobial regimen. Methods Data were retrospectively collected from a 3,500-bed regional medi...
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2025-01-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-025-10454-z |
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| author | Sheng Deng Jinglan Chen Pengxiang Zhou Qin Hu |
| author_facet | Sheng Deng Jinglan Chen Pengxiang Zhou Qin Hu |
| author_sort | Sheng Deng |
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| description | Abstract Objectives To determine the mortality-related risk factors for carbapenem-resistant Enterobacteriaceae (CRE) infection in hospitalized patients and to compare the clinical efficacy of different antimicrobial regimen. Methods Data were retrospectively collected from a 3,500-bed regional medical center between January 2021 and June 2022. Mortality-related risk factors were analyzed by the Cox proportional regression model for multivariate analysis. Results 120 patients were included and the all-cause mortality was 20.8% (25/120). Multivariate analysis showed that age (HR = 1.035, 95%CI: 1.002–1.070, P = 0.036), SOFA score (HR = 1.169,95%CI: 1.066–1.281, P = 0.001), central venous catheter (HR = 3.858, 95%CI: 1.411–10.547, P = 0.009), the length of hospital stay (HR = 0.868, 95% CI: 0.806–0.936, P = 0.000) and combination therapy (HR = 3.152, 95%CI: 1.205–8.245, P = 0.019) were independent mortality risk factors after CRE infection. All patients received definitive therapy and 65.0% (78/120) received sensitive drug treatment. Among those 65.4% (51/78) received combination therapy and 34.6% (27/78) received monotherapy. Subgroup analysis of the non-sepsis group showed significantly lower mortality in monotherapy than in combination therapy (0% versus 22.2%, P = 0.034). Patients who received carbapenem-containing therapy had significantly higher mortality than those who received carbapenem-sparing therapy (31.3% versus 13.9%, P = 0.022). CAZ-AVI-containing therapy presented a lower mortality (19.0%) and a higher 7-day microbiological clearance (47.6%) compared to other antimicrobial regimens, but there were no statistical significance (P>0.05). Conclusions Patients with older age, higher SOFA score, central venous catheter, shorter hospital stay after CRE infection may had poor outcomes. Since patients with non-sepsis have a lower mortality rate from monotherapy, combination antibiotic treatment should not be routinely recommended. Patients who received CAZ-AVI-containing therapy presented a lower mortality compared to other antimicrobial regimens without statistical significance, further larger sample size is needed for verification. |
| format | Article |
| id | doaj-art-2dc8f6d1524c42f4878f935f306b65f8 |
| institution | Kabale University |
| issn | 1471-2334 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | BMC Infectious Diseases |
| spelling | doaj-art-2dc8f6d1524c42f4878f935f306b65f82025-01-26T12:17:08ZengBMCBMC Infectious Diseases1471-23342025-01-0125111110.1186/s12879-025-10454-zMortality-related risk factors of carbapenem-resistant Enterobacteriaceae infection with focus on antimicrobial regimens optimization: a real-world retrospective study in ChinaSheng Deng0Jinglan Chen1Pengxiang Zhou2Qin Hu3Department of Pharmacy, Xiangya Hospital, Central South UniversityDepartment of Pharmacy, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous RegionDepartment of Pharmacy, Peking University Third HospitalDepartment of Pharmacy, Xiangya Hospital, Central South UniversityAbstract Objectives To determine the mortality-related risk factors for carbapenem-resistant Enterobacteriaceae (CRE) infection in hospitalized patients and to compare the clinical efficacy of different antimicrobial regimen. Methods Data were retrospectively collected from a 3,500-bed regional medical center between January 2021 and June 2022. Mortality-related risk factors were analyzed by the Cox proportional regression model for multivariate analysis. Results 120 patients were included and the all-cause mortality was 20.8% (25/120). Multivariate analysis showed that age (HR = 1.035, 95%CI: 1.002–1.070, P = 0.036), SOFA score (HR = 1.169,95%CI: 1.066–1.281, P = 0.001), central venous catheter (HR = 3.858, 95%CI: 1.411–10.547, P = 0.009), the length of hospital stay (HR = 0.868, 95% CI: 0.806–0.936, P = 0.000) and combination therapy (HR = 3.152, 95%CI: 1.205–8.245, P = 0.019) were independent mortality risk factors after CRE infection. All patients received definitive therapy and 65.0% (78/120) received sensitive drug treatment. Among those 65.4% (51/78) received combination therapy and 34.6% (27/78) received monotherapy. Subgroup analysis of the non-sepsis group showed significantly lower mortality in monotherapy than in combination therapy (0% versus 22.2%, P = 0.034). Patients who received carbapenem-containing therapy had significantly higher mortality than those who received carbapenem-sparing therapy (31.3% versus 13.9%, P = 0.022). CAZ-AVI-containing therapy presented a lower mortality (19.0%) and a higher 7-day microbiological clearance (47.6%) compared to other antimicrobial regimens, but there were no statistical significance (P>0.05). Conclusions Patients with older age, higher SOFA score, central venous catheter, shorter hospital stay after CRE infection may had poor outcomes. Since patients with non-sepsis have a lower mortality rate from monotherapy, combination antibiotic treatment should not be routinely recommended. Patients who received CAZ-AVI-containing therapy presented a lower mortality compared to other antimicrobial regimens without statistical significance, further larger sample size is needed for verification.https://doi.org/10.1186/s12879-025-10454-zCarbapenem resistant EnterobacteriaceaeCREMortalityAntimicrobial agentsCeftazidime avibactamCAZ-AVI |
| spellingShingle | Sheng Deng Jinglan Chen Pengxiang Zhou Qin Hu Mortality-related risk factors of carbapenem-resistant Enterobacteriaceae infection with focus on antimicrobial regimens optimization: a real-world retrospective study in China BMC Infectious Diseases Carbapenem resistant Enterobacteriaceae CRE Mortality Antimicrobial agents Ceftazidime avibactam CAZ-AVI |
| title | Mortality-related risk factors of carbapenem-resistant Enterobacteriaceae infection with focus on antimicrobial regimens optimization: a real-world retrospective study in China |
| title_full | Mortality-related risk factors of carbapenem-resistant Enterobacteriaceae infection with focus on antimicrobial regimens optimization: a real-world retrospective study in China |
| title_fullStr | Mortality-related risk factors of carbapenem-resistant Enterobacteriaceae infection with focus on antimicrobial regimens optimization: a real-world retrospective study in China |
| title_full_unstemmed | Mortality-related risk factors of carbapenem-resistant Enterobacteriaceae infection with focus on antimicrobial regimens optimization: a real-world retrospective study in China |
| title_short | Mortality-related risk factors of carbapenem-resistant Enterobacteriaceae infection with focus on antimicrobial regimens optimization: a real-world retrospective study in China |
| title_sort | mortality related risk factors of carbapenem resistant enterobacteriaceae infection with focus on antimicrobial regimens optimization a real world retrospective study in china |
| topic | Carbapenem resistant Enterobacteriaceae CRE Mortality Antimicrobial agents Ceftazidime avibactam CAZ-AVI |
| url | https://doi.org/10.1186/s12879-025-10454-z |
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