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Oka K, Matsumoto A, Tetsuka N, Morioka H, Iguchi M, Ishiguro N, Nagamori T, Takahashi S, Saito N, Tokuda K, Igari H, Fujikura Y, Kato H, Kanai S, Kusama F, Iwasaki H, Furuhashi K, Baba H, Nagao M, Nakanishi M, Kasahara K, Kakeya H, Chikumi H, Ohge H, Azuma M, Tauchi H, Shimono N, Hamada Y, Takajo I, Nakata H, Kawamura H, Fujita J, Yagi T. Clinical characteristics and treatment outcomes of carbapenem-resistant Enterobacterales infections in Japan. J Glob Antimicrob Resist 2022; 29:247-252. [PMID: 35429667 DOI: 10.1016/j.jgar.2022.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The dissemination of difficult-to-treat carbapenem-resistant Enterobacterales (CRE) is of great concern. We clarified the risk factors underlying CRE infection mortality in Japan. METHODS We conducted a retrospective, multicentre, observational cohort study of patients with CRE infections at 28 university hospitals from September 2014 to December 2016, using the Japanese National Surveillance criteria. Clinical information, including patient background, type of infection, antibiotic treatment, and treatment outcome, was collected. The carbapenemase genotype was determined using PCR sequencing. Multivariate analysis was performed to identify the risk factors for 28-day mortality. RESULTS Among the 179 patients enrolled, 65 patients (36.3%) had bloodstream infections, with 37 (20.7%) infections occurring due to carbapenemase-producing Enterobacterales (CPE); all carbapenemases were of IMP-type (IMP-1: 32, IMP-6: 5). Two-thirds of CPE were identified as Enterobacter cloacae complex. Combination therapy was administered only in 46 patients (25.7%), and the 28-day mortality rate was 14.3%. Univariate analysis showed that solid metastatic cancer, Charlson Comorbidity Index ≥3, bloodstream infection, pneumonia, or empyema, central venous catheters, mechanical ventilation, and prior use of quinolones were significant risk factors for mortality. Multivariate analysis revealed that mechanical ventilation (OR: 6.71 [1.42-31.6], P = 0.016), solid metastatic cancers (OR: 5.63 [1.38-23.0], P = 0.016), and bloodstream infections (OR: 3.49 [1.02-12.0], P = 0.046) were independent risk factors for 28-day mortality. CONCLUSION The significant risk factors for 28-day mortality in patients with CRE infections in Japan are mechanical ventilation, solid metastatic cancers, and bloodstream infections.
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Affiliation(s)
- Keisuke Oka
- Department of Infectious Diseases, Nagoya University Hospital, Showa-ku, Nagoya, Aichi, Japan
| | - Akane Matsumoto
- Department of Pediatrics, Kyoto Katsura Hospital, Saikyou-ku, Kyoto, Japan
| | - Nobuyuki Tetsuka
- Department of Infection Control, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hiroshi Morioka
- Department of Infectious Diseases, Nagoya University Hospital, Showa-ku, Nagoya, Aichi, Japan
| | - Mitsutaka Iguchi
- Department of Infectious Diseases, Nagoya University Hospital, Showa-ku, Nagoya, Aichi, Japan
| | - Nobuhisa Ishiguro
- Division of Infection Control, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Tsunehisa Nagamori
- Department of Infection Control, Asahikawa Medical University Hospital, Asahikawa, Hokkaido, Japan
| | - Satoshi Takahashi
- Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Norihiro Saito
- Department of Clinical Laboratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Koichi Tokuda
- Department of Infection Control and Laboratory Diagnostics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hidetoshi Igari
- Division of Infection Control, Chiba University Hospital, Chiba, Chiba, Japan
| | - Yuji Fujikura
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Hideaki Kato
- Infection Prevention and Control Department, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Shinichiro Kanai
- Department of Infection Control, Shinshu University Hospital, Matsumoto, Nagano, Japan
| | - Fumiko Kusama
- Department of Clinical Laboratory, Niigata University Medical and Dental Hospital, Niigata, Niigata, Japan
| | - Hiromichi Iwasaki
- Department of Infection Control and Prevention, University of Fukui, Fukui, Fukui, Japan
| | - Kazuki Furuhashi
- Department of Laboratory Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hisashi Baba
- Centre for Nutrition Support and Infection Control, Gifu University Hospital, Gifu, Gifu, Japan
| | - Miki Nagao
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Masaki Nakanishi
- Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan
| | - Kei Kasahara
- Centre for Infectious Diseases, Nara Medical University, Kashihara, Nara, Japan
| | - Hiroshi Kakeya
- Department of Infection Control Science, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Osaka, Japan
| | - Hiroki Chikumi
- Centre for Infectious Diseases, Tottori University Hospital, Yonago, Tottori, Japan
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
| | - Momoyo Azuma
- Department of Infection Control, Tokushima University Hospital, Tokushima, Tokushima, Japan
| | - Hisamichi Tauchi
- Division of Infectious Disease, Control and Prevention, Ehime University Hospital, Toon, Ehime, Japan
| | - Nobuyuki Shimono
- Centre for the Study of Global Infection, Kyushu University Hospital, Fukuoka, Fukuoka, Japan
| | - Yohei Hamada
- Department of Infectious Disease and Hospital Epidemiology, Saga University Hospital, Saga, Saga, Japan
| | - Ichiro Takajo
- Center for Infection Control, Miyazaki University Hospital, Miyazaki, Miyazaki, Japan
| | - Hirotomo Nakata
- Department of Infection Control, Kumamoto University Hospital, Kumamoto, Kumamoto, Japan
| | - Hideki Kawamura
- Department of Infection Control, Kagoshima University Hospital, Kagoshima, Kagoshima, Japan
| | - Jiro Fujita
- Department of Infectious, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Nakagami-gun, Okinawa, Japan
| | - Tetsuya Yagi
- Department of Infectious Diseases, Nagoya University Hospital, Showa-ku, Nagoya, Aichi, Japan.
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