Background: Carbapenem-resistant Enterobacteriaceae (CRE) colonization is associated with bacterial translocation, which can result in subsequent endogenous CRE infection. In the present study, we aim to investigate the colonization-related risk factors and molecular epidemiological characteristics of CRE in patients with acute leukemia.
Methods: From January 2021 to December 2021, acute leukemia patients were screened for CRE by fecal/perianal swabs. We identified the species, carbapenemase-encoding genes, and virulence genes of the colonizing strains and performed antimicrobial susceptibility tests and ERIC-PCR typing. Risk factors for CRE colonization were identified by univariate and multivariate analysis.
Results: We collected a total of 21 colonizing strains from 320 patients. All strains were resistant to meropenem. Klebsiella pneumoniae was the most abundant species, and ERIC-PCR typing showed low diversity. Univariate analysis showed that age, cephalosporins, penicillins, tigecyclines, and hematopoietic stem cell transplantation status were risk factors for CRE colonization; simultaneously discovered CRE strains played a dominant role in invasive infection of colonized patients. Logistic multivariate regression analysis showed that age, cephalosporins, and tigecyclines were independent risk factors for CRE intestinal colonization.
Conclusion: CRE colonization can increase the incidence of CRE infection in patients with acute leukemia. Early detection of CRE colonization through CRE screening is an important measure to control the spread of CRE.



中文翻译：

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急性白血病患者耐碳青霉烯类肠杆菌的肠道定植：危险因素和分子特征

背景：耐碳青霉烯类肠杆菌科 (CRE) 定植与细菌易位有关，可导致随后的内源性 CRE 感染。在本研究中，我们旨在调查急性白血病患者 CRE 定植相关的危险因素和分子流行病学特征。
方法： 2021年1月至2021年12月，对急性白血病患者进行粪便/肛周拭子筛查CRE。我们确定了定植菌株的种类、碳青霉烯酶编码基因和毒力基因，并进行了抗菌药敏试验和 ERIC-PCR 分型。通过单变量和多变量分析确定 CRE 定植的危险因素。
结果：我们从 320 名患者中收集了总共 21 种定植菌株。所有菌株均对美罗培南耐药。肺炎克雷伯菌是最丰富的物种，ERIC-PCR分型显示多样性较低。单因素分析显示，年龄、头孢菌素类、青霉素类、替加环素类、造血干细胞移植状态是CRE定植的危险因素；同时发现CRE菌株在定植患者的侵袭性感染中起主导作用。Logistic多元回归分析显示，年龄、头孢菌素和替加环素是CRE肠道定植的独立危险因素。
结论：CRE定植可增加急性白血病患者CRE感染的发生率。通过CRE筛查及早发现CRE定植是控制CRE传播的重要措施。