Outcomes and mortality risk scoring for infections caused by carbapenem-resistant Escherichia coli and Klebsiella pneumoniae
Introduction: Carbapenem-resistant Enterobacterales (CRE) are becoming increasingly prevalent and have been associated with increased mortality. Due to the paucity of data from the region, we evaluated the risk factors and outcomes of infections caused by CRE at a tertiary care center in Lebanon....
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The Journal of Infection in Developing Countries
2025-05-01
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| Series: | Journal of Infection in Developing Countries |
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| Online Access: | https://jidc.org/index.php/journal/article/view/20725 |
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| author | Jack El Sawda Jawan Abdulrahim Rayyan Wazzi Mkahal George Doumat Tamara Nawar Antoine Saliba Souha S Kanj Zeina A Kanafani |
| author_facet | Jack El Sawda Jawan Abdulrahim Rayyan Wazzi Mkahal George Doumat Tamara Nawar Antoine Saliba Souha S Kanj Zeina A Kanafani |
| author_sort | Jack El Sawda |
| collection | DOAJ |
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Introduction: Carbapenem-resistant Enterobacterales (CRE) are becoming increasingly prevalent and have been associated with increased mortality. Due to the paucity of data from the region, we evaluated the risk factors and outcomes of infections caused by CRE at a tertiary care center in Lebanon.
Methodology: The study had three arms in a case-case-control design: patients with CRE infections, patients with infections due to ceftriaxone-resistant carbapenem-susceptible Enterobacterales (CSE), and uninfected controls (UC). Logistic regression was performed to identify risk factors uniquely associated with CRE. A CRE infection score was also created to assess the likelihood of having a CRE infection.
Results: We included 337 patients (112 CRE, 75 CSE, 150 UC). Predictors unique to CRE infection included recent surgery (Odds Ratio (OR) 25.7; 95% confidence interval (CI95 5.7-115.2), carbapenem use within 30 days (OR 19.1; CI95 3.3-109.6), and malignancy (OR 4.2; CI95 1.6-10.5). The mean CRE score was 4.2 ± 2.2 in the CRE group and 2.4 ± 2.4 in the CSE group (p < 0.001). Infection-related mortality was higher among CRE patients (63.6% vs. 20.0%; p = 0.015), and CRE was independently associated with all-cause in-hospital mortality.
Conclusions: We developed a scoring system that would allow risk stratification and would guide empiric antibiotic therapy. CRE infections were associated with a worse outcome compared to CSE infections.
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| format | Article |
| id | doaj-art-c55fa35fd5a04d238c69f7d05cf6459d |
| institution | Kabale University |
| issn | 1972-2680 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | The Journal of Infection in Developing Countries |
| record_format | Article |
| series | Journal of Infection in Developing Countries |
| spelling | doaj-art-c55fa35fd5a04d238c69f7d05cf6459d2025-08-20T03:47:19ZengThe Journal of Infection in Developing CountriesJournal of Infection in Developing Countries1972-26802025-05-01190510.3855/jidc.20725Outcomes and mortality risk scoring for infections caused by carbapenem-resistant Escherichia coli and Klebsiella pneumoniaeJack El Sawda0Jawan Abdulrahim1Rayyan Wazzi Mkahal2George Doumat3Tamara Nawar4Antoine Saliba5Souha S Kanj6Zeina A Kanafani7Washington University School of Medicine in St. Louis, St. Louis, MI, United StatesDuke University, Durham, NC, United StatesAmerican University of Beirut, Beirut, LebanonHarvard Medical School, Boston, MA, United StatesMemorial Sloan Kettering Cancer Center, New York, NY, United StatesMayo Clinic, Rochester, MN, United StatesAmerican University of Beirut, Beirut, LebanonAmerican University of Beirut, Beirut, Lebanon Introduction: Carbapenem-resistant Enterobacterales (CRE) are becoming increasingly prevalent and have been associated with increased mortality. Due to the paucity of data from the region, we evaluated the risk factors and outcomes of infections caused by CRE at a tertiary care center in Lebanon. Methodology: The study had three arms in a case-case-control design: patients with CRE infections, patients with infections due to ceftriaxone-resistant carbapenem-susceptible Enterobacterales (CSE), and uninfected controls (UC). Logistic regression was performed to identify risk factors uniquely associated with CRE. A CRE infection score was also created to assess the likelihood of having a CRE infection. Results: We included 337 patients (112 CRE, 75 CSE, 150 UC). Predictors unique to CRE infection included recent surgery (Odds Ratio (OR) 25.7; 95% confidence interval (CI95 5.7-115.2), carbapenem use within 30 days (OR 19.1; CI95 3.3-109.6), and malignancy (OR 4.2; CI95 1.6-10.5). The mean CRE score was 4.2 ± 2.2 in the CRE group and 2.4 ± 2.4 in the CSE group (p < 0.001). Infection-related mortality was higher among CRE patients (63.6% vs. 20.0%; p = 0.015), and CRE was independently associated with all-cause in-hospital mortality. Conclusions: We developed a scoring system that would allow risk stratification and would guide empiric antibiotic therapy. CRE infections were associated with a worse outcome compared to CSE infections. https://jidc.org/index.php/journal/article/view/20725Carbapenem resistancerisk stratificationEnterobacterales |
| spellingShingle | Jack El Sawda Jawan Abdulrahim Rayyan Wazzi Mkahal George Doumat Tamara Nawar Antoine Saliba Souha S Kanj Zeina A Kanafani Outcomes and mortality risk scoring for infections caused by carbapenem-resistant Escherichia coli and Klebsiella pneumoniae Journal of Infection in Developing Countries Carbapenem resistance risk stratification Enterobacterales |
| title | Outcomes and mortality risk scoring for infections caused by carbapenem-resistant Escherichia coli and Klebsiella pneumoniae |
| title_full | Outcomes and mortality risk scoring for infections caused by carbapenem-resistant Escherichia coli and Klebsiella pneumoniae |
| title_fullStr | Outcomes and mortality risk scoring for infections caused by carbapenem-resistant Escherichia coli and Klebsiella pneumoniae |
| title_full_unstemmed | Outcomes and mortality risk scoring for infections caused by carbapenem-resistant Escherichia coli and Klebsiella pneumoniae |
| title_short | Outcomes and mortality risk scoring for infections caused by carbapenem-resistant Escherichia coli and Klebsiella pneumoniae |
| title_sort | outcomes and mortality risk scoring for infections caused by carbapenem resistant escherichia coli and klebsiella pneumoniae |
| topic | Carbapenem resistance risk stratification Enterobacterales |
| url | https://jidc.org/index.php/journal/article/view/20725 |
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