Analysis of clinical characteristics of patients with coronavirus disease 2019 based on a superior carbapenem-resistant Enterobacterales identification strategy

Secondary infection is a common complication in patients diagnosed with coronavirus disease 2019 (COVID-19) and often leads to complexity in clinical treatment. Due to the irregular use of prescribed antibiotics, carbapenem-resistant Enterobacterales (CRE) have gradually emerged. Empirical antibiotic treatment often encounters obstacles in patients with COVID-19 coinfected with CRE. This study aimed to establish a protocol for carbapenemase detection to guide the standardized use of antibiotics and improve patient prognosis. The performance of GeneXpert Carba-R and immunochromatography were evaluated for the detection of carbapenemases in 115 gram-negative isolates to develop an optimal scheme for carbapenemase detection. The clinical characteristics of 44 patients diagnosed with COVID-19 complicated by CRE were retrospectively analyzed, and clinical outcomes before and after implementation of the proposed strategy were compared. The overall accuracy, sensitivity, and specificity of the 2 respective methods were as follows: 98.3%, 98.9%, and 95.4%; and 97.4%, 96.8%, and 100%. A proposed scheme combining the advantages of the 2 carbapenemase detection methods was developed through a comprehensive comparison. Results demonstrated that patients with COVID-19 complicated by CRE were significantly older than those with carbapenem-susceptible Enterobacterales infection (P < .05). Moreover, such patients frequently had underlying diseases or underwent clinically invasive ventilation and were prone to complications including respiratory failure (P < .05). There was no significant difference in the 28-day survival rate of patients with COVID-19 complicated by CRE before and after the implementation of the proposed carbapenemase detection scheme, although the mean length of hospital stay was significantly shorter (P < .05). The authors propose an efficient and practical carbapenemase detection protocol tailored to a resource-limited laboratory, which had a positive impact on enhancing the clinical prognosis of patients with COVID-19 complicated by CRE infection.