Global epidemiology and clinical outcomes of carbapenem-resistant Pseudomonas aeruginosa and associated carbapenemases (POP): a prospective cohort study

作者：Jinnethe Reyes, Lauren Komarow, Liang Chen, Lizhao Ge, Blake Hanson, Eric Cober, Erica Herc, Thamer H. Alenazi, Keith S. Kaye, Julia Garcia‐Diaz, Lanjuan Li, Souha S. Kanj, Zhengyin Liu, Jose M Oñate, Robert A. Salata, Kalisvar Marimuthu, Hainv Gao, Zhiyong Zong, Sandra Valderrama, Yunsong Yu, Paul Anantharajah Tambyah, Gregory Weston, Soraya Salcedo, Lillian M Abbo, Qing Xie, Karen Ordóñez, Minggui Wang, Martín E. Stryjewski, José M. Munita, David L. Paterson, Scott Evans, Carol Hill, Keri Baum, Robert A. Bonomo, Barry N. Kreiswirth, María Virginia Villegas, Robin Patel, César A. Arias, Henry F. Chambers, Vance G. Fowler, Yohei Doi, David van Duin, Michael J. Satlin, Jinnethe Reyes, Lauren Komarow, Liang Chen, Lizhao Ge, Blake Hanson, Eric Cober, Erica Herc, Thamer H. Alenazi, Keith S. Kaye, Julia Garcia‐Diaz, Lanjuan Li, Souha S. Kanj, Zhengyin Liu, Jose M Oñate, Robert A. Salata, Kalisvar Marimuthu, Hainv Gao, Zhiyong Zong, Sandra Valderrama, Yunsong Yu, Paul Anantharajah Tambyah, Gregory Weston, Soraya Salcedo, Lillian M Abbo, Qing Xie, Karen Ordóñez, Minggui Wang, Martín E. Stryjewski, José M. Munita, David L. Paterson, Scott Evans, Carol Hill, Keri Baum, Robert A. Bonomo, Barry N. Kreiswirth, María Virginia Villegas, Robin Patel, César A. Arias, Henry F. Chambers, Vance G. Fowler, Yohei Doi, David van Duin, Michael J. Satlin · 发表于：The Lancet Microbe · 年份：2023 · DOI：10.1016/s2666-5247(22)00329-9 · 被引用次数：320 · 研究领域：Antibiotic Resistance in Bacteria、Infections and bacterial resistance、Nosocomial Infections in ICU

BACKGROUND: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a global threat, but the distribution and clinical significance of carbapenemases are unclear. The aim of this study was to define characteristics and outcomes of CRPA infections and the global frequency and clinical impact of carbapenemases harboured by CRPA. METHODS: We conducted an observational, prospective cohort study of CRPA isolated from bloodstream, respiratory, urine, or wound cultures of patients at 44 hospitals (10 countries) between Dec 1, 2018, and Nov 30, 2019. Clinical data were abstracted from health records and CRPA isolates were whole-genome sequenced. The primary outcome was 30-day mortality from the day the index culture was collected. We compared outcomes of patients with CRPA infections by infection type and across geographic regions and performed an inverse probability weighted analysis to assess the association between carbapenemase production and 30-day mortality. FINDINGS: We enrolled 972 patients (USA n=527, China n=171, south and central America n=127, Middle East n=91, Australia and Singapore n=56), of whom 581 (60%) had CRPA infections. 30-day mortality differed by infection type (bloodstream 21 [30%] of 69, respiratory 69 [19%] of 358, wound nine [14%] of 66, urine six [7%] of 88; p=0·0012) and geographical region (Middle East 15 [29%] of 52, south and central America 20 [27%] of 73, USA 60 [19%] of 308, Australia and Singapore three [11%] of 28, China seven [6%] of 120; p=0·0002...