Risk factors and outcomes of carbapenem-resistant Escherichia coli nosocomial infections in a Chinese teaching hospital: A retrospective study from 2013 to 2020

Abstract

Abstract Background: The emergence of carbapenem-resistant Escherichia coli (E. coli) strains poses a considerable challenge to global public health, but little is known about carbapenemase- producing E. coli in Tianjin, China. This study was undertaken to investigate the risk factors for infections with carbapenem-resistant E. coli (CREC) strains. Methods We conducted a retrospective case‒control study in a tertiary teaching hospital. A total of 134 CREC clinical isolates was collected from the general hospital of Tianjin Medical University from 2013 to 2020. The control group was selected at a ratio of 1:1 from patients with nosocomial carbapenem-susceptible E. coli infections. Risk factors for nosocomial CREC infections and clinical outcomes were analyzed by univariate and multivariate analyses. Results Multivariate analysis showed that cephalosporin exposure (odd ratio OR=2.01; 95% confidence interval [CI], 1.13-3.59; p=0.02), carbapenem exposure (OR=1.96; 95%CI, 1.10-3.50; p=0.02), glucocorticoids exposure (OR=32.45; 95%CI, 4.15-253.60; p=0.001); and surgical history (OR=3.26; 95%CI, 1.80-5.88; p＜0.001) were independent risk factors for CREC infections. The in-hospital mortality rate in the CREC group was 29.1%, and age>65 years old (OR=3.19; 95%CI, 1.29-7.90; p=0.01), carbapenem exposure (OR=3.54; 95%CI, 1.26-9.98; p=0.02), and central venous catheter insertion (OR=4.19; 95%CI, 1.70-10.31; p=0.002) were independent risk factors for in-hospital mortality in patients with CREC infections. Conclusion Many factors were found to be involved in nosocomial CREC infections. CREC isolates were resistant to most antibiotics, and reducing the mortality of CREC needs comprehensive consideration of whether the antibiotics were used appropriately, underlying diseases and invasive operation.