Outcomes and mortality risk scoring for infections caused by carbapenem-resistant Escherichia coli and Klebsiella pneumoniae

Authors

  • Jack El Sawda Washington University School of Medicine in St. Louis, St. Louis, MI, United States
  • Jawan Abdulrahim Duke University, Durham, NC, United States
  • Rayyan Wazzi Mkahal American University of Beirut, Beirut, Lebanon
  • George Doumat Harvard Medical School, Boston, MA, United States
  • Tamara Nawar Memorial Sloan Kettering Cancer Center, New York, NY, United States
  • Antoine Saliba Mayo Clinic, Rochester, MN, United States https://orcid.org/0000-0001-5134-7336
  • Souha S Kanj American University of Beirut, Beirut, Lebanon
  • Zeina A Kanafani American University of Beirut, Beirut, Lebanon https://orcid.org/0000-0001-8814-1286

DOI:

https://doi.org/10.3855/jidc.20725

Keywords:

Carbapenem resistance, risk stratification, Enterobacterales

Abstract

Introduction: Carbapenem-resistant Enterobacterales (CRE) are becoming increasingly prevalent and have been associated with increased mortality. Due to the paucity of data from the region, we evaluated the risk factors and outcomes of infections caused by CRE at a tertiary care center in Lebanon.

Methodology: The study had three arms in a case-case-control design: patients with CRE infections, patients with infections due to ceftriaxone-resistant carbapenem-susceptible Enterobacterales (CSE), and uninfected controls (UC). Logistic regression was performed to identify risk factors uniquely associated with CRE. A CRE infection score was also created to assess the likelihood of having a CRE infection.

Results: We included 337 patients (112 CRE, 75 CSE, 150 UC). Predictors unique to CRE infection included recent surgery (Odds Ratio (OR) 25.7; 95% confidence interval (CI95 5.7-115.2), carbapenem use within 30 days (OR 19.1; CI95 3.3-109.6), and malignancy (OR 4.2; CI95 1.6-10.5). The mean CRE score was 4.2 ± 2.2 in the CRE group and 2.4 ± 2.4 in the CSE group (p < 0.001). Infection-related mortality was higher among CRE patients (63.6% vs. 20.0%; p = 0.015), and CRE was independently associated with all-cause in-hospital mortality.

Conclusions: We developed a scoring system that would allow risk stratification and would guide empiric antibiotic therapy. CRE infections were associated with a worse outcome compared to CSE infections.

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Published

2025-05-31

How to Cite

1.
El Sawda J, Abdulrahim J, Mkahal RW, Doumat G, Nawar T, Saliba A, Kanj SS, Kanafani ZA (2025) Outcomes and mortality risk scoring for infections caused by carbapenem-resistant Escherichia coli and Klebsiella pneumoniae. J Infect Dev Ctries 19:683–690. doi: 10.3855/jidc.20725

Issue

Vol. 19 No. 05: May 2025

Section

Original Articles

License

Copyright (c) 2025 Jack El Sawda, Jawan Abdulrahim, Rayyan Mkahhal, George Doumat, Tamara Nawwar, Antoine Saliba, Souha Kanj, Zeina Kanafani

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