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Risk Factors and Outcomes for Isolation with Polymyxin B-Resistant Enterobacterales from 2018-2022: A Case-Control
Wenjuan Yan1, Jiaojiao Wu2, Shanmei Wang1
1Department of Clinical Microbiology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, Henan, People's Republic of China.
Purpose:
To analyze the risk factors and clinical outcomes of patients isolated with polymyxin B-resistant (PR) Enterobacterales from various clinical specimens to prevent and control the spread of these strains.
Methods:
This retrospective case-control study included 72 PR Enterobacterales-positive cases and 144 polymyxin B-susceptible (PS) Enterobacterales controls from 2018 to 2022. Patients with PR Enterobacterales isolated in various clinical cultures were defined as cases. Patients with PS Enterobacterales cultures at similar anatomic sites during the same period were randomly selected as controls. Data were collected from clinical and laboratory test records. Bivariable logistic regression and Pearson's chi-square tests were used to assess risk factors.
Results:
PR strains were predominantly Klebsiella pneumoniae (72.2%) and Salmonella enteritidis (8.3%). Of the patients, 66.04% were admitted to an intensive care unit (ICU). Risk factors for isolation with PR strains included chronic heart disease (P = 0.012; odds ratio [OR] 1.15; 95% confidence interval [CI] 1.03-1.28), immunosuppressant use (P = 0.016; OR 1.04 [1.0-1.07), drainage tube [head] (P = 0.006; OR 1.1 [1.0-1.1]), and polymyxin B exposure (P = 0.007; OR 1.03 [1.0-1.06]. With respect to outcomes, admission to an ICU (P = 0.003; OR 7.1 [1.9-25.4]), hypertension (P = 0.035; OR 1.4 [1.02-1.83]), and drainage tube [head] (P = 0.044; OR 1.1 [1.0-1.15]) were associated with treatment failure. Additionally, treatment failure was more frequent in patients (45.83%) than in controls (14.58%).
Conclusion:
The major risk factors for isolation with PR strains were chronic heart disease, exposure to immunosuppressants, use of drainage tubes, and polymyxin B exposure. The isolation of PR strains in patients was a predictor of unfavorable outcomes. These findings provide a basis for monitoring the spread of PR Enterobacterales.
Insights
Polymyxin B-resistant Enterobacterales infections are linked to chronic heart disease, immunosuppression, drainage tubes, and prior polymyxin B exposure. These resistant strains predict unfavorable outcomes, highlighting the need for monitoring their spread.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Antimicrobial Resistance
Background:
- The emergence of polymyxin B-resistant (PR) Enterobacterales poses a significant threat to public health.
- Understanding the risk factors and clinical outcomes associated with PR Enterobacterales is crucial for effective infection control.
- Enterobacterales are a common cause of hospital-acquired infections, and resistance to last-resort antibiotics like polymyxin B is a growing concern.
Purpose of the Study:
- To identify risk factors associated with the isolation of polymyxin B-resistant (PR) Enterobacterales from clinical specimens.
- To analyze the clinical outcomes of patients infected with PR Enterobacterales.
- To provide data for the prevention and control of the spread of PR Enterobacterales strains.
Main Methods:
- A retrospective case-control study was conducted from 2018 to 2022.
- 72 patients with PR Enterobacterales isolates (cases) were compared with 144 patients with polymyxin B-susceptible (PS) Enterobacterales isolates (controls).
- Data on patient demographics, clinical characteristics, and laboratory records were collected and analyzed using bivariable logistic regression and Pearson's chi-square tests.
Main Results:
- Predominant PR strains were Klebsiella pneumoniae (72.2%) and Salmonella enteritidis (8.3%).
- Significant risk factors for PR Enterobacterales isolation included chronic heart disease, immunosuppressant use, drainage tube placement, and prior polymyxin B exposure.
- Treatment failure was more frequent in patients with PR strains (45.83%) compared to controls (14.58%), and was associated with ICU admission, hypertension, and drainage tube use.
Conclusions:
- Chronic heart disease, immunosuppression, drainage tubes, and polymyxin B exposure are key risk factors for PR Enterobacterales isolation.
- Isolation of PR Enterobacterales is a significant predictor of unfavorable clinical outcomes, including treatment failure.
- These findings underscore the importance of monitoring the prevalence and spread of PR Enterobacterales to guide antimicrobial stewardship and infection control strategies.
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