比較碳青黴烯酶的有無對具碳青黴烯類抗藥性的克雷伯氏肺炎桿菌菌血症患者的預後影響

Comparing the Outcomes of Patients with Carbapenemase-producing and Non-carbapenemase-producing Carbapenem-resistant Klebsiella pneumoniae Bacteremia

具碳青黴烯類抗藥性的腸桿菌根據其抗藥機轉可分為具碳青黴烯酶和不具碳青黴烯酶，而碳青黴烯酶對病人預後的影響仍不明確，因此我們比較產碳青黴烯酶抗碳青黴烯類克雷伯氏肺炎桿菌（carbapenemase-producing carbapenemresistant Klebsiella pneumoniae, CP-CRKP）和非產碳青黴烯酶抗碳青黴烯類克雷伯氏肺炎桿菌（non-carbapenemase-producing carbapenem-resistant Klebsiellapneumoniae, non-CP-CRKP）之菌血症病人的死亡率。
我們回溯性研究收集2012年8月到2019年12月期間，因感染抗碳青黴烯類克雷伯氏肺炎桿菌（carbapenem-resistant Klebsiella pneumoniae, CRKP）菌血症而於臺北榮民總醫院住院的病人，使用聚合酶連鎖反應偵測菌血症分離株的碳青黴烯酶，再利用Cox迴歸分析找出與14天死亡率相關的風險因子。
此研究期間收集了165位CRKP菌血症病人，包括115位（69.7%）感染CP-CRKP和50位（30.3%）感染non-CP-CRKP，整體14天死亡率為41.8%，前者的14天死亡率比後者顯著較高（47.0% vs 30.0%, p=0.042），多變項分析顯示帶有碳青黴烯酶並非14天死亡率的獨立因子，血液腫瘤之共病症（風險比=2.678，95%信賴區間=1.457-4.922，p=0.002）、Pitt Bacteremia score（風險比=1.179，95%信賴區間=1.017-1.367，p=0.029）和敗血性休克（風險比=2.223，95%信賴區間=1.016-4.865，p=0.046）為顯著的危險因子。
由此發現感染CRKP菌血症有著很高的死亡率，但是否帶有碳青黴烯酶與14天死亡率無顯著相關。

Carbapenem-resistant Enterobacterales (CRE) develop resistance through two main mechanisms: carbapenemase-producing (CP) and non-carbapenemaseproducing (non-CP). However, it remains unclear whether carbapenemase production affects patient mortality. Therefore, this study aimed to compare the mortality of patients with carbapenemase-producing carbapenem-resistant Klebsiella pneumoniae (CP-CPKP) and non-carbapenemase-producing carbapenemresistant Klebsiella pneumoniae (non-CP-CRKP) bacteremia.
We conducted an observational study including patients with carbapenemresistant Klebsiella pneumoniae (CRKP) bacteremia hospitalized at Taipei Veterans General Hospital from August 1, 2012, to December 31, 2019. The primary outcome was 14- day mortality. Polymerase chain reaction was performed on all isolates to identify carbapenemase-encoding genes. The relationships between clinical variables and outcomes were analyzed using Cox regression models. A total of 165 patients with CRKP bacteremia were retrospectively analyzed, including 115 with CP-CRKP and 50 with non-CP-CRKP bacteremia. The overall 14-day mortality rate was 41.8%. Patients with CP-CRKP bacteremia had a higher 14-day mortality rate than those with non-CP-CRKP (47.0% vs. 30.0%, p = 0.042). Multivariable analysis revealed that carbapenemase production was not independently associated with 14- day mortality. Independent risk factors for 14-day mortality included hematologic malignancy (hazard ratio, 2.678; 95% confidence interval, 1.457–4.922; p = 0.002), high Pitt bacteremia score (hazard ratio, 1.179; 95% confidence interval, 1.017–1.367; p = 0.029), and septic shock (hazard ratio, 2.223; 95% confidence interval, 1.016–4.865; p = 0.046). Our findings suggest that patients with CRKP bacteremia have high 14-day mortality; however, carbapenemase production was not associated with 14-day mortality in CRKP bacteremia.