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Background <p>Carbapenem-Resistant Gram-Negative Bacteria, including Carbapenem-Resistant <i>Enterobacterales</i> (CRE) and Carbapenem-Resistant <i>Pseudomonas aeruginosa</i> (CRPA), are common causes of infections in intensive care units (ICUs) in Italy.</p> Objective <p>This prospective observational study evaluated the epidemiology, management, microbiological characterization, and outcomes of hospital-acquired CRE or CRPA infections treated in selected ICUs in Italy.</p> Methods <p>The study included patients with hospital-acquired infections due to CRE and CRPA treated in 20 ICUs from June 2021 to February 2023. The primary endpoint was the 1-year incidence of CRE/CRPA infections. Secondary endpoints included the rate of CRE/CRPA infections, mortality in ICU, infection outcome, and microbiological characterization.</p> Results <p>Among 13,088 patients admitted over the 12-month study period across each of the 20 ICUs, 283 had CRE infections, and 138 had CRPA infections. The incidence of CRE and CRPA infections was 3.57 per 1000 patient days and 1.74 per 1000 patient days, respectively. The proportion of CRE and CRPA infections over the total number of infections due to <i>Enterobacterales</i> and <i>Pseudomonas aeruginosa</i> was 19.2% and 26.8%, respectively. Among 158 patients included in the full analysis, 98 (62%) had CRE infections and 60 (38%) had CRPA infections. Ventilator-associated pneumonia and bloodstream infections were the most common infections, occurring in 53.8 and 34.2% of cases. Empirical therapy targeting gram-negative pathogens resulted inappropriate in 59.2% of analysed patients (77/130). The overall crude mortality in ICU rate was 30.4%, with a higher rate in CRE patients (36.7%) than in CRPA patients (20.0%). Clinical success, including microbiological eradication, was achieved in 50.6% of cases. <i>Klebsiella pneumoniae</i> was observed as the predominant CRE species, and all CRE isolates, including metallo-β-lactamases-producing CRE (MBL-CRE), were susceptible to Aztreonam-Avibactam.</p> Conclusions <p>These results highlight the high prevalence of CRE/CRPA infections in Italian ICUs and emphasize the need for enhanced prevention and surveillance strategies.</p>

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Incidence of hospital-acquired infections due to carbapenem-resistant Enterobacterales and Pseudomonas aeruginosa in critically ill patients in Italy: a multicentre prospective cohort study

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  • 发表日期：

    2025年1月17日

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  • Gennaro De Pascale,
  • Andrea Cortegiani,
  • Matteo Rinaldi,
  • Massimo Antonelli,
  • Sergio Cattaneo,
  • Maurizio Cecconi,
  • Raffaele Cuffaro,
  • Lidia Dalfino,
  • Filomena Di Biase,
  • Abele Donati,
  • Francesca Romana Fasano,
  • Teresa Fasciana,
  • Giuseppe Foti,
  • Antonella Frattari,
  • Roberto Fumagalli,
  • Massimo Girardis,
  • Leonardo Gottin,
  • Alessia Mattei,
  • Marta Milazzo,
  • Giorgia Montrucchio,
  • Daniela Pasero,
  • Fabio Picciafuochi,
  • Emanuela Sensi,
  • Giuseppe Servillo,
  • Maria Alejandra Vidal Pereira,
  • Teresa Spanu,
  • Pierluigi Viale,
  • Salvatore Lucio Cutuli,
  • Eloisa Sofia Tanzarella,
  • Simone Carelli,
  • Luca Montini,
  • Antonino Giarratano,
  • Romina Aceto,
  • Erminia Casari,
  • Luca Brazzi,
  • Antonio Curtoni,
  • Lucia Serio,
  • Filippo Ferrari,
  • Vincenzo Savini,
  • Matteo Taiana,
  • Annarita Mazzariol,
  • Simone Ambretti,
  • Grazia Merola,
  • Linda Degl’Innocenti,
  • Renato Ricciardi,
  • Giovanni Gherardi,
  • Fernando Arnaiz Guerrero,
  • Chiara Vismara,
  • Elena Vittorielli,
  • Erika Casarotta,
  • Maria Vargas,
  • Roberto Rona,
  • Annalisa Cavallero,
  • Angela Muroni,
  • Salvatore Rubino,
  • Bruno Viaggi,
  • Tommaso Giani,
  • Mariachiara Ippolito,
  • Beatrice Tiri,
  • Stefano Cappanera,
  • Alessandro Mariottini,
  • Monica Stufano,
  • Adriana Mosca,
  • Giacomo Monti,
  • Fabio Buffoli

摘要

Background

Carbapenem-Resistant Gram-Negative Bacteria, including Carbapenem-Resistant Enterobacterales (CRE) and Carbapenem-Resistant Pseudomonas aeruginosa (CRPA), are common causes of infections in intensive care units (ICUs) in Italy.

Objective

This prospective observational study evaluated the epidemiology, management, microbiological characterization, and outcomes of hospital-acquired CRE or CRPA infections treated in selected ICUs in Italy.

Methods

The study included patients with hospital-acquired infections due to CRE and CRPA treated in 20 ICUs from June 2021 to February 2023. The primary endpoint was the 1-year incidence of CRE/CRPA infections. Secondary endpoints included the rate of CRE/CRPA infections, mortality in ICU, infection outcome, and microbiological characterization.

Results

Among 13,088 patients admitted over the 12-month study period across each of the 20 ICUs, 283 had CRE infections, and 138 had CRPA infections. The incidence of CRE and CRPA infections was 3.57 per 1000 patient days and 1.74 per 1000 patient days, respectively. The proportion of CRE and CRPA infections over the total number of infections due to Enterobacterales and Pseudomonas aeruginosa was 19.2% and 26.8%, respectively. Among 158 patients included in the full analysis, 98 (62%) had CRE infections and 60 (38%) had CRPA infections. Ventilator-associated pneumonia and bloodstream infections were the most common infections, occurring in 53.8 and 34.2% of cases. Empirical therapy targeting gram-negative pathogens resulted inappropriate in 59.2% of analysed patients (77/130). The overall crude mortality in ICU rate was 30.4%, with a higher rate in CRE patients (36.7%) than in CRPA patients (20.0%). Clinical success, including microbiological eradication, was achieved in 50.6% of cases. Klebsiella pneumoniae was observed as the predominant CRE species, and all CRE isolates, including metallo-β-lactamases-producing CRE (MBL-CRE), were susceptible to Aztreonam-Avibactam.

Conclusions

These results highlight the high prevalence of CRE/CRPA infections in Italian ICUs and emphasize the need for enhanced prevention and surveillance strategies.