Wen Zhu, Yi Liang, Feifei Dai
Secondary-care hospitals present high prevalence of CPE, accompanied by a substantial mortality burden among infected patients. This study provides evidence-based guidance for optimizing CPE management.
OBJECTIVE: To analyze clinical characteristics of carbapenemase-producing Enterobacterales (CPE) infection and explore factors associated with their short-term (30-day) and long-term (90-day) prognostic outcomes.
METHODS: A retrospective cohort study enrolled 192 non-duplicate patients with microbiologically confirmed CRE infection between January 2023 and June 2025 at a secondary-care hospital. All isolates underwent carbapenemase detection. Demographic data, clinical features, laboratory findings, treatment interventions, and 30-day/90-day prognostic outcomes were collected. Kaplan-Meier survival curves were generated, and the Log-rank tests were used for intergroup survival comparison. Univariate and multivariate Cox proportional hazards regression models were employed to identify independent prognostic factors for 30-day and 90-day mortality.
RESULTS: All CRE isolates were confirmed as carbapenemase producers, with significant antimicrobial susceptibility differences. The 30-day and 90-day all-cause mortality rates were 23.43% (95% CI: 17.39-29.48%) and 27.60% (95% CI: 21.22-33.98%), respectively. Multivariate analyses revealed independent associations with 30-day mortality, including septic shock/sepsis (aHR = 2.528, 95% CI: 1.126-5.678), fasting plasma glucose (aHR = 1.113, 95% CI: 1.034-1.197), and hospital-onset infection (aHR = 2.246, 95% CI: 1.145-4.406). For 90-day mortality, additional factors included albumin infusion (aHR = 3.081, 95% CI: 1.350-7.096) and MBL type (aHR = 2.410, 95% CI: 1.301-4.465). Appropriate antimicrobial therapy was significantly associated with reduced 30-day (aHR = 0.424, 95% CI: 0.219-0.823) and 90-day (aHR = 0.346, 95% CI: 0.182-0.659) mortality risk.
CONCLUSIONS: Secondary-care hospitals present high prevalence of CPE, accompanied by a substantial mortality burden among infected patients. This study provides evidence-based guidance for optimizing CPE management.