Risk factors in non‑surviving patients with infection with carbapenemase‑producing Enterobacterales strains in an intensive care unit

Vlad,Nicoleta-Dorina; Dumea,Elena; Cambrea,Claudia-Simona; Puscasu,Cristina Gabriela; Ionescu,Constantin; Averian,Bianca; Mihai,Raluca-Vasilica; Dumitru,Andrei; Dumitru,Irina-Magdalena

doi:10.3892/mi.2023.90

Risk factors in non‑surviving patients with infection with carbapenemase‑producing Enterobacterales strains in an intensive care unit

Authors:
- Nicoleta-Dorina Vlad
- Elena Dumea
- Claudia-Simona Cambrea
- Cristina Gabriela Puscasu
- Constantin Ionescu
- Bianca Averian
- Raluca-Vasilica Mihai
- Andrei Dumitru
- Irina-Magdalena Dumitru
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Affiliations: Clinical Infectious Diseases Hospital of Constanta, 900709 Constanța, Romania, Faculty of Dentistry, Ovidius University of Constanța, 900470 Constanta, Romania, Faculty of Medicine, Ovidius University of Constanța, 900470 Constanta, Romania, Doctoral School of Medicine, Ovidius University of Constanța, 900470 Constanta, Romania
Published online on: June 14, 2023 https://doi.org/10.3892/mi.2023.90
Article Number: 30
Copyright : © Vlad et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].

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Abstract

Carbapenemase‑producing Enterobacterales (CPE) are Gram‑negative bacteria that belong to the Enterobacterales family and produce enzymes known as carbapenemases, which inhibit carbapenems, cephalosporins and penicillins. Carbapenem‑resistant Enterobacterales (CRE) are resistant to carbapenems, cephalosporins and penicillins via mechanisms that may or may not produce carbapenemases. The identification of carbapenems is critical for the initiation of proper antibiotic therapy. The present case‑control, retrospective study included 64 patients with CPE strains admitted to an intensive care unit between September, 2017 and October, 2021; of these, 34 patients with CPE succumbed and 30 control patients with CPE strains survived. CPE strains in the deceased patients were caused by Klebsiella spp. in 31 cases (91.2%) and Escherichia coli in 3 cases (8.8%). The univariate analysis revealed that the predictive factors associated with mortality in patients with CPE were admission with coronavirus disease 2019 (COVID‑19) (P=0.001), invasive mechanical ventilation (P=0.001), and treatment with corticosteroids (P=0.006). The multivariate analysis revealed that admission with COVID‑19 [odds ratio (OR), 16.26; 95% confidence interval (CI), 3.56‑74.14; P≤0.05] and invasive mechanical ventilation (OR, 14.98; 95% CI, 1.35‑166.22; P≤0.05) were associated with mortality as independent risk factors. Admission with COVID‑19 increased the risk of mortality 16.26‑fold and invasive mechanical ventilation increased the risk of mortality by 14.98‑fold. On the whole, the present study demonstrates that the length of hospital duration in patients who acquired CPE did not influence mortality, whereas infection with COVID‑19 increased and invasive mechanical ventilation were associated with an increased risk of mortality.

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