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Updated: Oct 2, 2026
Non-Invasive Model of Neuropathogenic Escherichia coli Infection in the Neonatal Rat
Published on: October 29, 2014
Clinical and microbiological characteristics of carbapenem-resistant Enterobacteriaceae causing post-operative
Hangbin Hu1, Hao Wang2, Meihong Yu3
1Department of Nutrition, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Objectives:
Postoperative central nervous system infections (PCNSIs) caused by carbapenem-resistant Enterobacteriaceae (CRE) frequently result in unfavourable outcomes. However, CRE PCNSIs have not been well described from a clinical and microbiological perspective.
Methods:
A total of 254 PCNSIs cases were included (January 2017 through June 2020), and clinical features were compared based on pathogenic classification. Cox regression analysis was performed to assess risk factors for mortality. Antibiotic susceptibility testing and whole genome sequencing were conducted on CRE isolates preserved. MLST, cgMLST, resistance genes and virulence genes were further analysed.
Results:
Among 254 PCNSI cases, 15.4% were caused by Enterobacteriaceae including 28 cases by CRE. The 28-day mortality rates for CRE, CSE and non-Enterobacteriaceae PCNSIs were 50.0%, 27.3%, and 7.4%, respectively. 42.9% (12/28) of the CRE PCNSIs patients achieved clinical cure, with 25.0% achieved microbiological clearance. ST11-KL64 carrying blaKPC-2 was dominant in CRE (17/23, 73.9%), and the 28-day mortality rate of its infection was 58.5%. Most CRKP carried rampA/rampA2 genes (17/23, 73.9%).
Conclusion:
ST11-KL64 CRKP carrying blaKPC-2 dominated among CRE PCNSIs. Targeted anti-infective combination therapy based on ceftazidime/avibactam or amikacin, combined with intrathecal administration of amikacin, was found to be effective. These findings render a new insight into the clinical and microbiological landscape of CRE PCNSIs.
Insights
Postoperative central nervous system infections (PCNSIs) caused by carbapenem-resistant Enterobacteriaceae (CRE) have high mortality. ST11-KL64 carbapenem-resistant Klebsiella pneumoniae (CRKP) carrying blaKPC-2 was dominant, and combination therapy showed effectiveness.
Area of Science:
- Infectious Diseases
- Microbiology
- Genomics
Background:
- Postoperative central nervous system infections (PCNSIs) caused by carbapenem-resistant Enterobacteriaceae (CRE) are associated with poor outcomes.
- Limited clinical and microbiological data exist for CRE PCNSIs.
Purpose of the Study:
- To describe the clinical and microbiological characteristics of CRE PCNSIs.
- To identify risk factors for mortality in PCNSIs.
- To evaluate treatment efficacy for CRE PCNSIs.
Main Methods:
- Retrospective analysis of 254 PCNSI cases (January 2017-June 2020).
- Comparison of clinical features based on pathogen classification.
- Cox regression for mortality risk factors.
- Antibiotic susceptibility testing and whole genome sequencing (MLST, cgMLST, resistance/virulence genes) of CRE isolates.
Main Results:
- CRE accounted for 15.4% of PCNSIs (28 cases).
- 28-day mortality rates: CRE (50.0%), carbapenem-susceptible Enterobacteriaceae (CSE) (27.3%), non-Enterobacteriaceae (7.4%).
- ST11-KL64 carrying blaKPC-2 was dominant in CRE (73.9%), with a 58.5% mortality rate. RampA/rampA2 genes were common in CRKP (73.9%).
Conclusions:
- ST11-KL64 carbapenem-resistant Klebsiella pneumoniae (CRKP) carrying blaKPC-2 is the predominant pathogen in CRE PCNSIs.
- Combination therapy with ceftazidime/avibactam or amikacin, plus intrathecal amikacin, demonstrated effectiveness.
- Findings provide new insights into the clinical and microbiological landscape of CRE PCNSIs.
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