Abstract
Background
Carbapenem-resistant Enterobacterales (CRE) have become a major global public health concern. The production and spread of carbapenemases have rendered carbapenemase-producing Enterobacterales (CPE) a severe clinical threat. Epidemiological data regarding CPE infections remain scarce in secondary hospitals. This study aims to characterize carbapenemase phenotypes and antimicrobial resistance profiles of CRE isolates from a secondary hospital, and explore factors associated with patient clinical outcome.Methods
A cohort study was conducted on clinical CRE isolates collected from January 2023 to September 2024. Carbapenemases were identified by immunochromatography. Univariate and multivariate logistic regression models were conducted to identify factors associated with clinical failure of CPE-infected patients.Results
Of 131 strains from enrolled CRE infected patients, the detection rate of carbapenemases was 100% via immunochromatography. Phenotypes distribution revealed 98 (74.8%) Klebsiella pneumoniae carbapenemase (KPC), 25 (19.1%) metallo-β-lactamases (MBL) and 8 (6.1%) double carbapenemases-producer (DCP), with distinct antimicrobial resistance features across groups. Elevated aCCI (aOR 1.4, 95% CI 1.1-1.8, p = 0.007), mechanical ventilation (aOR 7.8, 95% CI 2.2-28.1, p = 0.002) and hospital-onset (aOR 6.7, 95% CI 2.0-23.0, p = 0.002) were independent factors associated with clinical failure.Conclusion
The secondary hospitals face intense carbapenemase prevalence pressure and complex resistance profiles, particularly among DCP strains. Patients with more comorbidities and hospital-acquired infection may develop poor clinical outcomes. These findings underscore the urgent need for enzyme-guided precision therapy and tailored infection control strategies in these high-risk, community-linked medical institutions.Clinical trial number
Not applicable.