AUTHOR=Lin Qiuxia , Wu Menglu , Yu Hanbing , Jia Xiaojiong , Zou Hua , Ma Deyu , Niu Siqiang , Huang Shifeng 

TITLE=Clinical and Microbiological Characterization of Carbapenem-Resistant Enterobacteriales: A Prospective Cohort Study

JOURNAL=Frontiers in Pharmacology

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2021.716324

DOI=10.3389/fphar.2021.716324

ISSN=1663-9812

ABSTRACT=<p><bold>Aim:</bold> We aim to depict the clinicoepidemiological and molecular information of carbapenem-resistant <italic>Enterobacteriales</italic> (CRE) in Chongqing, China.</p><p><bold>Methods:</bold> We performed a prospective, observational cohort study, recruiting inpatients diagnosed with CRE infections from June 1, 2018, to December 31, 2019. We carried out strain identification and molecular characterization of CRE. eBURST analysis was conducted to assess the relationships among the different isolates on the basis of their sequence types (STs) and associated epidemiological data using PHYLOViZ. Clinical parameters were compared between the carbapenemase-producing <italic>Enterobacteriales</italic> (CPE) and non-CPE group.</p><p><bold>Findings:</bold> 128 unique CRE isolates from 128 patients were collected during the study period: 69 (53.9%) CPE and 59 (46.1%) non-CPE. The majority of CPE isolates were <italic>bla</italic><sub>KPC-2</sub> (56.5%), followed by <italic>bla</italic><sub>NDM</sub> (39.1%) and <italic>bla</italic><sub>IMP</sub> (5.8%). <italic>Klebsiella pneumoniae</italic> carbapenemase (KPC)–producing clonal group 11 <italic>Klebsiella pneumoniae (K. pneumoniae)</italic> was the most common CPE. Antibiotic resistance was more frequent in the CPE group than in the non-CPE group. Independent predictors for CPE infection were ICU admission and hepatobiliary system diseases. Although, there was no significant difference in desirability of outcome ranking (DOOR) outcomes between the two groups. At 30 days after index culture, 35 (27.3% ) of these patients had died.</p><p><bold>Conclusion:</bold> CRE infections were related to high mortality and poor outcomes, regardless of CRE subgroups. CPE were associated with prolonged ICU stays and had different clinical and microbiological characteristics than non-CPE. The identification of CPE/non-CPE and CRE resistance mechanisms is essential for better guidance of the clinical administration of patients with CRE infections.</p>