Drug resistance of CRE in hospital-acquired infections and clinical outcomes of infected patients
Objective To investigate the drug resistance of carbapenem-resistant enterobacteriaceae(CRE)in hospital-ac-quired infections and the clinical outcomes of infected patients.Methods A total of 341 adult patients with CRE infection hospitalized in Sichuan Provincial Corps Hospital of Chinese People's Armed Police Force from January 2017 to June 2023 were selected as the case group,336 patients with carbapenem sensitive enterobacteriidae(CSE)infection were selected as the sensitive group,and 354 hospitalized patients with non-enterobacteriidae infection during the same period were selected as the control group.The minimum in-hibitory concentration of commonly used antibiotics to CRE were detected by drug sensitive strip and broth dilution method,and univa-riate and multivariate methods were used to analyze the clinical outcomes of hospital-acquired CRE patients.Results The most com-mon types of CRE were sputum,urine and blood,and the top three types of CRE were carbapenem-resistant Klebsiella pneumoniae(CR-Kp),carbapenem-resistant Escherichia coli(CR-Eco)and carbapenem-resistant Enterobacter cloacae(CR-Ecl).Tigecycline and colistin were the top two sensitive drugs of CR-Kpn and CR-Eco in vitro.The sensitivity rate of tetracycline to CR-Kpn was 71.86%,while the sensitivity rate of tetracycline to CR-Eco was low.The sensitivity rate of nitrofuranins and aminoglycosides to CR-Eco was significantly higher than that of CR-Kpn.There was no significant difference in in-hospital mortality between CRE group and the other two groups(P>0.05),but the poor prognosis rate of CRE group(19.35%)was higher than that of CSE group(11.31%)and control group(12.15%),with statistical significance(P<0.05).In patients with CRE infection,renal insufficiency and the use of immunosuppressive agents were independent predictors of poor prognosis,while the empirical use of antibiotics was a protective fac-tor.Conclusions Colistin and tigecycline have higher antibacterial activity against CRE than other commonly used antibiotics.Nitrofuran-toin and aminoglycoside antibiotics are suitable for infection caused by CR-Eco.Hospital-acquired CRE infection is prone to lead to poor prognosis in patients,but the empirical use of antibiotics can effectively reduce the adverse clinical outcomes caused by CRE infection.
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