The Correlation Between Intestinal CRE Colonization And Subsequent Systemic Infection In Hospitalized Patients

Background: Infection caused by Carbapenem-resistant Enterobacteriaceae(CRE)continues to increase worldwide and has become a major global public health threat.At present,it is generally believed that CRE colonization is a prerequisite for infection.However,it is not clear what is the probability of subsequent infection after colonization,what factors are related to,and what is the outcome subsequent infection.In addition,excessive decolonization treatment may also lead to waste of medical resources and abuse of antibiotics.There is no unified conclusion on the specific timing and necessity of CRE decolonization therapy.Currently,the subsequent development of CRE infection in CRE transplant patients in China is not clear.Objectives: The main purpose of this study is to identify the population traits,pathogenic characteristics and risk factors of systemic infection after intestinal CRE colonization in inpatients,and in order to establish a risk prediction model of subsequent infection in CRE carriers,so as to identify high-risk inpatients early and give timely intervention measures for decolonization treatment,so that we can achieve the goal of prevention and control of CRE nosocomial infection.Methods: A total of 546 intestinal CRE colonization samples of inpatients in Xiangya Hospital of Central South University from January1,2013 to November 30,2021 were collected retrospectively.Finally,55 patients with CRE infection and 159 patients without CRE infection were included.The related information and clinical data of the two groups were collected retrospectively,and the data were analyzed by SPSS software 26.0.The R was used to plot the risk prediction model of systemic infection after intestinal CRE colonization in inpatients.Results: Infection occurred after intestinal CRE colonization in inpatients,which not only significantly prolonged the length of stay and increased the total cost of hospitalization,but also increased the burden of anti-infective treatment.The main type of CRE infection strain was Klebsiella pneumoniae,followed by Escherichia coli and Enterobacter cloacae.The most common source of infection was respiratory sputum,followed by blood flow,and then digestive tract and urinary tract samples.Respiratory Department,Hematology Department,intensive care unit and other specialized ICU are high risk departments for subsequent infection.Multivariate Logistic regression analysis showed that the use of probiotics and oral administration combined with intravenous antibiotics were protective factors in patients with intestinal CRE colonization,which may reduce the risk of subsequent development of CRE infection,while the underlying diseases combined with liver disease and digestive tract disease,the history of surgery or trauma in the last 3 months,and the use of polymyxin and antifungal antibiotics were independent risk factors.Finally,a risk model of Nomograph for predicting systemic infection following intestinal CRE colonization in hospitalized patients was established.Conclusions: Subsequent infection after intestinal CRE colonization in inpatients can significantly prolong the length of stay and increased the total cost of hospitalization.There are many influencing factors for infection after CRE colonization in hospitalized patients.For patients with CRE colonization in high-risk departments,clinicians should refer to the Nomograph prediction model,correctly select antimicrobial treatment and timely intervene related risk factors.Clinicians should correctly choose antimicrobial treatment and timely intervene related risk factors.At the same time,they should also do a good job in the prevention and control of CRE colonization or infection.