Abstract

OLIVEROS NAVARRO, Aida et al. Bacteremia due to carbapenem-resistant Enterobacteriaceae: A cross-sectional study. Infect. [online]. 2015, vol.19, n.2, pp.60-66. ISSN 0123-9392.  https://doi.org/10.1016/j.infect.2014.11.006.

Objectives: To describe the clinical features, antibiotic regimes and prognosis in terms of inpatient mortality and adverse effects in patients with Enterobacteriaceae bacteremia anda positive carbapenemase-detecting phenotypic test. Materials and methods: A cross-sectional study was conducted at a tertiary hospital (Medellín,Colombia). Patients with blood stream infections by carbapenems-resistant Enterobacteriaceae(CRE) diagnosed from January, 2010 to December, 2013 were included. Continuous variables are presented as medians and interquartile ranges (IQR), and categorical variables are presentedas percentages. Results: Sixty-four cases were included, with a mean age of 62 ± 14; 66% were male (n = 42).A total of 60% (n = 38) were admitted to the ICU and the median APACHE-II score was 17 (IQR:12-22), with high comorbidity (Charlson score = 3, IQR: 2-5). The median hospital stay prior to the diagnosis of bacteremia was 21 days (IQR: 13-39). Klebsiella pneumoniae was isolated in 64%, Serratia marcescens in 20% and Enterobacter spp. in 11% of the cases. Some 45% had apositive screening before the diagnosis of bacteremia. Mortality at 28 days was 51.6% (n = 33)and occurred in a median of 5 days (IQR: 2-17) after bloodstream infection was detected. Definitive treatment was a combination of antibiotics for 76.6%, but no combination scheme was prevalent. Adverse effects were observed in one of 3 patients and the median hospital stay was46 days (IQR: 26-76). Mortality at 28 days was 40.7% when patients were treated with a combination that included carbapenems agents (n = 27), compared with 55.2% for colistin (n = 27) and 55,7% for tigecycline (n = 18). Discussion: A high comorbidity index and nosocomial environment exposure were observed,as in previously published studies. The 28-day mortality was comparable to that reported inother studies. There was less mortality in patients treated with a combination that includeda carbapenem agent, as was reported in a recent clinical study on patients with bacteremia Klebsiella pneumoniae carbapenemase. Conclusions: CRE bacteremia is seen in very ill patients and is associated with high mortality. Bacterial colonization was detected in nearly half the patients prior to development of infection. The current antimicrobial therapy is heterogeneous, but the inclusion of a carbapenems agent in combination therapy may be associated with lower mortality.

Keywords : Carbapenemase-producing Enterobacteriaceae; Bloods treaminfection; KPC; Treatment.

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