Risk factors and clinical impact of carbapenem-resistant Enterobacterales coinfections among hospitalized patients with Clostridioides difficile infection

Ching-Chi Lee,1– 3,* Chun-Wei Chiu,4,* Jen-Chieh Lee,1 Pei-Jane Tsai,5– 7 Wen-Chien Ko,1,8 Yuan-Pin Hung1,4,8,9 1Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 704, Taiwan; 2Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan, 711, Taiwan; 3Clinical Medicine Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 704, Taiwan; 4Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan, 700, Taiwan; 5Department of Medical Laboratory Science and Biotechnology, National Cheng Kung University, College of Medicine, Tainan, 704, Taiwan; 6Department of Pathology, National Cheng Kung University Hospital, Tainan, Taiwan; 7Centers of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan, Taiwan; 8Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, 704, Taiwan; 9Department of Microbiology & Immunology, College of Medicine, National Cheng Kung University, Tainan, Taiwan*These authors contributed equally to this workCorrespondence: Yuan-Pin Hung, Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan, Email yuebin16@yahoo.com.tw Wen-Chien Ko, Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, Email winston3415@gmail.comIntroduction: The risk factors and clinical impact of carbapenem-resistant Enterobacterales (CRE) coinfection among hospitalized patients with Clostridioides difficile infection (CDI) were analyzed in this study.Materials and Methods: A clinical study was performed at the medical wards of Tainan Hospital, Ministry of Health and Welfare in southern Taiwan. Patients with CDI between January 2013 and April 2020 were included.Results: Among 238 patients included for analysis, 22 (9.2%) patients developed CRE coinfections within 14 days before or after the onset of CDI. CDI patients with CRE coinfection had longer hospitalization stays (103.0 ± 97.0 days vs 42.5 ± 109.6 days, P = 0.01) than those without CRE coinfection. In the multivariate analysis, age (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.01– 1.10, P = 0.02) was independently associated with CRE coinfection. In contrast, underlying old stroke (OR 0.15, 95% CI 0.03– 0.70, P = 0.02) was negatively linked to CRE coinfection.Conclusion: Among patients with CDI, CRE coinfections were associated with prolonged hospitalization for CDI. Age was an independent risk factor for CRE coinfection among patients with CDI.Keywords: carbapenem-resistant Enterobacterales, Clostridioides difficile infection, age, hypertension, recurrence, prolonged hospitalization