Clinical, microbiological characteristics and predictors of mortality in patients with carbapenemase-producing Enterobacterales bloodstream infections: a multicentre study

Abstract

Abstract Objectives To investigate the microbiological characteristics and clinical outcomes of patients with bloodstream infections (BSI) due to carbapenemase-producing Enterobacterales (CPE). Methods A multicentre retrospective service evaluation of patients with BSIs due to CPE admitted to six UK hospitals was conducted between 2011 and 2021. Multivariate analysis was used to identify factors predicting 30-day case fatality rate (CFR). Results There were 84 episodes of CPE-BSIs, 37 (44%) due to OXA-48, 35 (42%) to metallo-betalactamases (MBL) and 12 (14%) to KPC. 63% of patients were male with a median age of 64 years. Common organisms included Klebsiella spp. (61%), Escherichia coli (20%) and Enterobacter spp. (13%). Urinary devices were more often involved in OXA-48 BSIs (12/37; 32%) compared to infections caused by MBL and KPC (4/35; 11% and 1/12; 8%; p 0.046). In contrast, central venous catheters were more frequently present in KPC-BSIs (10/12; 92%) compared with OXA-48 and MBL (11/37; 30% and 20/35; 57%; p 0.002). Effective definitive antimicrobials were received by 72/84 (86%) patients – either empirically or following microbiology results – comprising monotherapy (32/72; 44%) or combination therapy (40/72; 56%). Overall, 30-day case fatality rate (CFR) was 38%. Sepsis or septic shock was associated with death [OR 3.81 (CI 1.19–12.14), p 0.024]. Conclusion CFR of CPE-BSI remains relatively high. We identified risks from urinary devices and intravenous catheters, but further larger studies are needed to characterise and compare the clinical and microbiological profile of BSIs due to different types of carbapenemases.