IMP-type carbapenemase, found in various Gram-negative bacteria, has been increasingly detected worldwide. We aimed to study the outcomes and risk factors for acquisition of IMP-type carbapenemase-producing carbapenem-resistant Enterobacteriaceae (IMP-CRE), as this has not been evaluated in detail. We conducted a matched case-case-control study of patients from whom IMP-CRE isolates were obtained. All patients who tested positive for IMP-CRE were included; they were matched with patients with carbapenem-susceptible Enterobacteriaceae (CSE) and with controls at a ratio of 1:1:2. The risk factors for acquisition for the CRE and CSE groups and mortality rates, which were calculated using multivariate logistic regression models with weighting according to the inverse probability of propensity scores, were compared. In total, 192 patients (96 patients each in the CRE and CSE groups, with 130 Enterobacter cloacae isolates and 62 Klebsiella sp. isolates) were included. The IMP-11 type was present in 43 patients, IMP-1 in 33, and IMP-60 and IMP-66 in 1 each; 31 patients with CRE (32.3%) and 34 with CSE (35.4%) developed infections. Multivariate analysis identified the following independent risk factors: gastrostomy, history of intravenous therapy or hemodialysis, and previous exposure to broad-spectrum β-lactam antibiotics, including penicillin with β-lactamase inhibitors, cephalosporins, and carbapenems. In propensity score-adjusted analysis, mortality rates for the CRE and CSE groups were similar (15.0% and 19.5%, respectively). We found that IMP-CRE may not contribute to worsened clinical outcomes, compared to CSE, and gastrostomy, previous intravenous therapy, hemodialysis, and broad-spectrum antimicrobial exposure were identified as risk factors for CRE isolation. Fluoroquinolone and aminoglycosides are potentially useful antibiotics for IMP-CRE infections.

中文翻译：

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日本产 IMP 型碳青霉烯酶碳青霉烯类耐药肠杆菌科患者临床结局和危险因素影响的匹配病例-病例对照研究

在各种革兰氏阴性菌中发现的 IMP 型碳青霉烯酶在世界范围内越来越多地被检测到。我们旨在研究获得 IMP 型产碳青霉烯酶的耐碳青霉烯肠杆菌科(IMP-CRE) 的结果和风险因素，因为尚未对此进行详细评估。我们对获得 IMP-CRE 分离株的患者进行了匹配的病例-病例对照研究。包括所有 IMP-CRE 检测呈阳性的患者；他们与碳青霉烯类敏感肠杆菌科患者相匹配(CSE) 并以 1:1:2 的比例进行控制。比较了 CRE 和 CSE 组的收购风险因素和死亡率，这些因素是使用根据倾向得分的逆概率加权的多变量逻辑回归模型计算的。总共 192 名患者（CRE 和 CSE 组各 96 名患者，130株阴沟肠杆菌和 62 株克雷伯氏菌sp。隔离）包括在内。IMP-11 型存在于 43 例患者中，IMP-1 型存在于 33 例中，IMP-60 和 IMP-66 型各有 1 例；31 名 CRE (32.3%) 患者和 34 名 CSE (35.4%) 患者出现感染。多变量分析确定了以下独立危险因素：胃造口术、静脉治疗或血液透析史，以及既往接触过广谱 β-内酰胺类抗生素，包括含 β-内酰胺酶抑制剂的青霉素、头孢菌素和碳青霉烯类。在倾向评分调整分析中，CRE 和 CSE 组的死亡率相似（分别为 15.0% 和 19.5%）。我们发现，与 CSE 相比，IMP-CRE 可能不会导致临床结果恶化，并且胃造口术、既往静脉治疗、血液透析和广谱抗菌素暴露被确定为 CRE 分离的危险因素。