Correlation between intestinal CRE colonization and subsequent systemic infection in hospitalized patients

Abstract

Abstract Purpose It is generally believed that Carbapenem-resistant Enterobacteriaceae (CRE) colonization is primarily responsible for subsequent systemic infection in humans. In China, the specific situation of CRE colonization and subsequent systemic infection in hospitalized patients necessitates further exploration. Methods We retrospectively analyzed data of intestinal CRE colonization inpatients at Xiangya Hospital, Central South University, regarding demography, clinical and pathogenic characteristics, treatment, and outcome. A risk prediction model for subsequent CRE infection was established and externally validated. Results In total, 839 intestinal CRE colonization samples from inpatients were included. Finally, 317 cases of intestinal CRE colonization were enrolled, 25.9% of whom developed systemic infections. The subsequent CRE infection rates of CRKP and CREC were 27.0% and 32.3%, respectively. The incidence of subsequent CRE infection in the respiratory medicine department, hematology department, and intensive care unit (ICU) was 26.7%, 21.8%, and 45.0%, respectively. Taking probiotics and the combined oral and intravenous administration of antibiotics were the protective factors for the subsequent infection of intestinal CRE colonization, while liver disease, agranulocytosis ≥ 7 days, hypoproteinemia, invasive respiratory assisted ventilation, history of surgery/trauma in the past 3 months, and use of antifungal drugs were the independent risk factors. Conclusions CRE infection after intestinal CRE colonization in inpatients can significantly prolong the length of hospital stay and increase total medical costs. The CRE infection group exhibited poor efficacy and high mortality. Thus, the established risk prediction model for intestinal infection after CRE colonization in hospitalized patients has a good prediction efficacy for high-risk departments.