Infection and Drug Resistance (Dec 2023)
Risk Factors and Outcomes for Isolation with Polymyxin B-Resistant Enterobacterales from 2018–2022: A Case-Control Study
Abstract
Wenjuan Yan,1,* Jiaojiao Wu,2,* Shanmei Wang,1 Qi Zhang,1 Youhua Yuan,1 Nan Jing,1 Jiangfeng Zhang,1 Hangchan He,3 Yi Li1 1Department of Clinical Microbiology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, Henan, People’s Republic of China; 2Department of Clinical Microbiology, Xiayi People’s Hospital, Shangqiu, Henan, People’s Republic of China; 3Department of Clinical Laboratory, Baofeng Traditional Chinese Medicine Hospital, Pingdingshan, Henan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yi Li, Department of Clinical Microbiology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, Henan, People’s Republic of China, Tel +8615939039006, Email [email protected]: To analyze the risk factors and clinical outcomes of patients isolated with polymyxin B-resistant (PR) Enterobacterales from various clinical specimens to prevent and control the spread of these strains.Methods: This retrospective case-control study included 72 PR Enterobacterales-positive cases and 144 polymyxin B-susceptible (PS) Enterobacterales controls from 2018 to 2022. Patients with PR Enterobacterales isolated in various clinical cultures were defined as cases. Patients with PS Enterobacterales cultures at similar anatomic sites during the same period were randomly selected as controls. Data were collected from clinical and laboratory test records. Bivariable logistic regression and Pearson’s chi-square tests were used to assess risk factors.Results: PR strains were predominantly Klebsiella pneumoniae (72.2%) and Salmonella enteritidis (8.3%). Of the patients, 66.04% were admitted to an intensive care unit (ICU). Risk factors for isolation with PR strains included chronic heart disease (P = 0.012; odds ratio [OR] 1.15; 95% confidence interval [CI] 1.03– 1.28), immunosuppressant use (P = 0.016; OR 1.04 [1.0– 1.07), drainage tube [head] (P = 0.006; OR 1.1 [1.0– 1.1]), and polymyxin B exposure (P = 0.007; OR 1.03 [1.0– 1.06]. With respect to outcomes, admission to an ICU (P = 0.003; OR 7.1 [1.9– 25.4]), hypertension (P = 0.035; OR 1.4 [1.02– 1.83]), and drainage tube [head] (P = 0.044; OR 1.1 [1.0– 1.15]) were associated with treatment failure. Additionally, treatment failure was more frequent in patients (45.83%) than in controls (14.58%).Conclusion: The major risk factors for isolation with PR strains were chronic heart disease, exposure to immunosuppressants, use of drainage tubes, and polymyxin B exposure. The isolation of PR strains in patients was a predictor of unfavorable outcomes. These findings provide a basis for monitoring the spread of PR Enterobacterales.Keywords: polymyxin B resistance, treatment failure, Klebsiella pneumoniae, Salmonella enteritidis
