AUTHOR=Tangsawad Watcharaphon , Kositamongkol Chayanis , Chongtrakool Piriyaporn , Phisalprapa Pochamana , Jitmuang Anupop 

TITLE=The burden of carbapenem-resistant Enterobacterales infection in a large Thai tertiary care hospital

JOURNAL=Frontiers in Pharmacology

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2022.972900

DOI=10.3389/fphar.2022.972900

ISSN=1663-9812

ABSTRACT=<p><bold>Background:</bold> Carbapenem-resistant <italic>Enterobacterales</italic> (CRE) are resistant to several other classes of antimicrobials, reducing treatment options and increasing mortality. We studied the clinical characteristics and burden of hospitalized adult patients with CRE infections in a setting where treatment options are limited.</p><p><bold>Methods:</bold> A retrospective cohort study included adult inpatients between January 2015–December 2019 at Siriraj Hospital in Bangkok, Thailand. Clinical and microbiological data were reviewed.</p><p>R<bold>esults</bold>: Of 420 patients with CRE infections, the mean age was 65.00 ± 18.89 years, 192 (45.72%) were male, and 112 (26.90%) were critically ill. Three hundred and eighty (90.48%) had <italic>Klebsiella pneumoniae</italic>, and 40 (9.52%) had <italic>Escherichia coli</italic> infections. The mean APACHE II score was 14.27 ± 6.36. Nearly half had previous hospitalizations (48.81%), 41.2% received antimicrobials, and 88.1% had undergone medical procedures before the onset of infection. The median time of onset of CRE infection was 16 days after admission. Common sites of infection were bacteremia (53.90%) and pneumonia (45.47%). Most CRE-infected patients had septic shock (63.10%) and Gram-negative co-infections (62.85%). Colistin (29.95%) and non-colistin (12.91%) monotherapies, and colistin-based (44.78%) and non-colistin-based (12.36%) combination therapies were the best available antimicrobial therapies (BAAT). The median length of hospitalization was 31 days, and the median hospitalization cost was US$10,435. The in-hospital mortality rate was 68.33%. Septic shock [adjusted odds ratio (aOR) 10.73, 5.65–20.42, <italic>p</italic> &lt;0 .001], coinfection (aOR 2.43, 1.32–4.47, <italic>p</italic> = 0.004), mechanical ventilation (aOR 2.33, 1.24–4.36, <italic>p</italic> = 0.009), and a high SOFA score at onset (aOR 1.18, 1.07–1.30, <italic>p</italic> &lt;0 .001) were associated with mortality.</p><p><bold>Conclusion:</bold> CRE infection increases mortality, hospital stays, and healthcare costs. A colistin-based regimen was the BAAT in this study. Therefore, newer antimicrobial agents are urgently needed.</p>