由于其高死亡率和有限的治疗选择，耐碳青霉烯酶肠杆菌（CPE）的增多已成为一个重大关注点。本研究旨在评估直肠CPE携带者发生CPE菌血症的发生率和特征，并与非产碳青霉烯酶（non-CP）肠杆菌菌血症进行比较，以研究CPE菌血症的危险因素。对2018年1月至2022年2月间在一家三级医院确认为CPE菌携带者的成年患者进行了回顾性分析，通过粪便监测培养确定CPE携带者发生菌血症6个月内的所有肠杆菌菌血症事件。 在被确定为直肠CPE携带者的1,174名患者中，69例（5.8%; 95%置信区间，4.6-7.3%）在CPE携带者确诊后的6个月内经历了CPE菌血症。CP-K. pneumoniae（肺炎克雷伯杆菌产碳青霉烯酶菌株）感染、多种CPE菌株的感染、慢性肾脏病和造血系统恶性肿瘤与CPE携带者的CPE菌血症独立相关。当CPE携带者发生肠杆菌菌血症时，引起菌血症的病原体更常见为非CP菌株而非CPE肠杆菌（63.6% vs 36.4%）。在这些患者中，KPC产碳青霉烯酶菌株的携带、多个部位的CPE菌株携带、从携带到菌血症的持续时间较短（<30天）和近期腹腔手术是CPE菌血症而非非CP肠杆菌菌血症的独立危险因素。 在CPE携带者中，非CP肠杆菌更常引起菌血症。如果存在CPE菌血症的危险因素，应考虑给予CPE的经验性抗生素治疗。版权所有 © 2023。Elsevier Ltd. 发布。

The rise of carbapenemase-producing Enterobacterales (CPE) has become a major concern due to its high mortality and the limited treatment options. This study aimed to evaluate the incidence and characteristics of subsequent CPE bacteremia in rectal CPE carriers and to investigate the risk factors for CPE bacteremia compared with non-carbapenemase-producing (non-CP) Enterobacterales bacteremia.A retrospective analysis was conducted on adult patients who were confirmed to have CPE colonization by stool surveillance culture at a tertiary hospital from January 2018 to February 2022. All episodes of Enterobacterales bacteremia up to 6 months after CPE colonization were identified.Of 1,174 patients identified as rectal CPE carriers, 69 (5.8%; 95% confidence interval, 4.6-7.3%) experienced subsequent CPE bacteremia during the 6 months after the diagnosis of CPE colonization. Colonization by a Klebsiella pneumoniae carbapenemase (KPC) producer (or CP-K. pneumoniae), colonization by multiple CPE species, chronic kidney disease, and hematologic malignancy were independently associated with CPE bacteremia in CPE carriers. When CPE carriers developed Enterobacterales bacteremia, the causative agent was more frequently non-CP than CPE Enterobacterales (63.6% vs 36.4%). Among these patients, colonization with KPC producer, CPE colonization at multiple sites, shorter duration from colonization to bacteremia (<30 days), and recent intraabdominal surgery were independent risk factors for CPE bacteremia rather than non-CP Enterobacterales bacteremia.In CPE carriers, non-CP Enterobacterales was more often responsible for bacteremia than CPE. When sepsis is suspected in a CPE carrier with risk factors for CPE bacteremia, empirical antibiotic therapy for CPE should be considered.Copyright © 2023. Published by Elsevier Ltd.