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Features of Carbapenem-resistant Gram-negative Bacterial Infections in Japan Based on the Setting of Onset
Yuya Kawamoto1,2, Yusuke Asai3,4, Aki Sakurai5
1Department of Infectious Diseases, Fujita Health University School of Medicine, Aichi, Japan.
Background:
Carbapenem-resistant Gram-negative bacilli (CR-GNB) are a major public health threat, traditionally linked to hospital settings. However, infections are increasingly reported in the community, and the clinical distinctions between community-associated (CA) and healthcare-associated (HA) infections remain unclear.
Methods:
We conducted a prospective multicenter study of hospitalized patients with CR-GNB infections across 13 Japanese tertiary hospitals between April 2019 and March 2024. Infections were categorized as CA, HA, or hospital-onset (HO) using standardized criteria. We compared patient demographics, microbiological findings, infection sites, and clinical outcomes based on the setting of onset.
Results:
Among 425 patients, 43 had CA, 59 HA, and 323 HO infections. Pseudomonas aeruginosa was the predominant pathogen in all groups. Aeromonas species were more frequently associated with CA than HO cases (23.3% of CA vs 2.2% of HO cases), whereas Stenotrophomonas maltophilia was detected almost exclusively among HO cases. Hospital-onset infections were associated with longer median hospital stays compared with CA infections (68 vs 17 days) and a trend toward higher 30-day mortality (23.9% vs 9.5%). In contrast, HA infections demonstrated no significant differences from CA infections in either hospital length of stay (23 vs 17 days) or 30-day mortality rate (10.3% vs 9.5%).
Conclusions:
Community-associated CR-GNB infections are an emerging concern in Japan, showing distinct pathogen profiles and infection sites compared to HO cases. Importantly, HA infections resembled CA infections in terms of clinical characteristics and outcomes, suggesting a need to reexamine the clinical relevance of current HA classification criteria for guiding therapy and risk stratification.
Insights
Community-associated carbapenem-resistant Gram-negative bacilli (CR-GNB) infections are rising in Japan. Healthcare-associated CR-GNB infections showed similar outcomes to community-associated ones, questioning current classification criteria.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Carbapenem-resistant Gram-negative bacilli (CR-GNB) pose a significant global health threat.
- CR-GNB infections are traditionally linked to healthcare settings but are increasingly reported in the community.
- Distinguishing between community-associated (CA) and healthcare-associated (HA) CR-GNB infections is challenging.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of CR-GNB infections based on their onset setting (CA, HA, hospital-onset).
- To compare patient demographics, pathogens, infection sites, and clinical outcomes across different CR-GNB infection categories.
- To evaluate the clinical relevance of current classification criteria for CR-GNB infections.
Main Methods:
- Prospective multicenter study involving 425 hospitalized patients with CR-GNB infections across 13 Japanese tertiary hospitals.
- Infections were classified as CA, HA, or hospital-onset (HO) using standardized criteria.
- Comparison of patient demographics, microbiological data, infection sites, and clinical outcomes.
Main Results:
- Pseudomonas aeruginosa was the most common pathogen across all groups.
- Aeromonas species were more prevalent in CA infections, while Stenotrophomonas maltophilia was mainly found in HO infections.
- HO infections had longer hospital stays and higher 30-day mortality compared to CA infections. HA infections showed no significant difference from CA infections in outcomes.
Conclusions:
- Community-associated CR-GNB infections present distinct pathogen profiles and infection sites compared to hospital-onset cases.
- Healthcare-associated CR-GNB infections exhibited similar clinical characteristics and outcomes to community-associated infections.
- Current HA classification criteria may require re-evaluation for effective therapeutic guidance and risk stratification.
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