Clinical outcomes and treatment effectiveness in patients with carbapenem-resistant Enterobacterales infections: a multicenter retrospective cohort study
Abdullah Awadh, Awadh Alhawiti, Abdulmajeed Alshehri, Mohammad Alhazmi, Ahmed Meny, Omar ArzounAbstract
Background:
Carbapenem-resistant Enterobacterales (CRE) infections carry high mortality and limited treatment options. We evaluated outcomes among adults with CRE infections at Ministry of National Guard-Health Affairs facilities in Saudi Arabia, comparing monotherapy with combination therapy.
Methods:
This multicenter retrospective cohort study included adults (≥18 years) with CRE infections during 2020–2024 at King Abdulaziz Medical City (Jeddah and Riyadh). CRE was defined phenotypically per CLSI criteria (first isolate per patient). Bivariate analyses, multivariate logistic regression, and Kaplan–Meier survival analysis compared monotherapy and combination therapy.
Results:
Among 224 patients (median age 70 years; 62.5% male), overall mortality was 43.3%, and Klebsiella pneumoniae accounted for 96.0% of isolates. Combination therapy was associated with higher mortality than monotherapy (44.5% vs. 26.7%; P = .047) and remained independently associated with mortality after adjustment for age, gender, and comorbidities (adjusted OR = 2.28, 95% CI: 1.08–4.83; P = .032). A significant treatment–mortality difference was seen in patients without solid tumors ( P = .031) but not in those with solid tumors ( P = 1.000). Respiratory and blood infections carried the highest mortality (58.3% and 55.3%).
Conclusions:
CRE infections carry a high mortality burden among adults in Saudi Arabia. The higher mortality with combination therapy may, in part, reflect confounding by indication, with broader-spectrum regimens prescribed for sicker patients whose severity was not captured. Prospective studies with disease-severity scoring and individualized treatment are needed, particularly for immunocompromised patients.