Bloodstream Infections Caused By Carbapenem-Resistant Enterobacteriaceae: Risk Factors, Treatment And Effects On Mortality

Introduction: Antimicrobial resistance is a global crisis that threatens the success of modern medical approaches. This is due to the emergence, spread, and persistence of multidrug-resistant bacteria, especially carbapenem-resistant Enterobacteriaceae (CRE).Materials and Methods: In this study, bloodstream infections caused by Enterobacteriaceae in our hospital were investigated retrospectively. As design, a retrospective cohort case-control study was used. Patients with CRE induced bloodstream infections (CREBSI) were identified as the case group while patients with carbapenem-susceptible Enterobacteriaceae induced bloodstream infections (CSEBSI) were identified as the control group. Demographic characteristics, risk factors, clinical and mortality data and treatment results were compared in both groups.Results: Mean age of the case and control groups was 68.9 +/- 17.0 years and 59.3 +/- 18.0 years, respectively. Age (p= 0.006), Charlson Comorbidity Index (CCI) (p= 0.002), and hospitalization in the intensive care unit (ICU) (p= 0.001) were found as risk factors for CREBSI. Previous use of antibiotics was identified as independent risk factors for CREBSI. Mortality indicators for all patients with bloodstream infection were identified to be diabetes mellitus (DM) (p= 0.041), APACHE-II score (p< 0.001), CCI (p= 0.005), and use of any antibiotic before culture (p< 0.001) in the univariate analysis. The only and independent mortality indicator was detected to be APACHE-II score in all patients with both CREBSI and CSEBSI (p< 0.001,ORadj: 1.3; 95% CI, 1.2-1.5). The presence of CREBSI was not identified as a risk factor for mortality in the multivariate analysis (p= 0.074). Survival time was longer in the case group patients who received combination therapy compared to the monotherapy patients.Conclusion: CREBSI threatens elderly patients, patients with comorbidity, patients hospitalized in the ICU for a long period of time and former use of antibiotics. Since all patients with both CREBSI and CSEBSI have a single and independent mortality indicator APACHE-II score, unnecessary antibiotic use can be avoided. In addition, strict infection control measures should be taken to control these infections.