{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T05:04:41Z","timestamp":1793423081404,"version":"4.5.0"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2023,11,30]],"date-time":"2023-11-30T00:00:00Z","timestamp":1701302400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,15]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Metallo-\u03b2-lactamase (MBL)\u2013producing Enterobacterales are increasing worldwide. Our aim was to describe clinical features, treatments, and outcomes of infections by MBL-Enterobacterales.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A prospective observational study conducted in the Pisa University Hospital (January 2019 to October 2022) included patients with MBL-producing Enterobacterales infections. The primary outcome measure was the 30-day mortality rate. Multivariable Cox regression analysis was performed to identify factors associated with that mortality rate, and adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were calculated.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The study\u2019s 343 patients included 15 with Verona integron-encoded MBL (VIM)- and 328 with New Delhi MBL (NDM)\u2013producing Enterobacterales infections; there were 199 patients (58%) with bloodstream infections, 60 (17.5%) with hospital-acquired or ventilator-associated pneumonia, 60 (17.5%) with complicated urinary tract infections, 13 (3.8%) with intra-abdominal infections, and 11 (3.2%) with skin and soft-tissue infections. The 30-day mortality rate was 29.7%. Of 343 patients, 32 did not receive in vitro active antibiotic therapy, 215 (62.7%) received ceftazidime-avibactam plus aztreonam, 33 (9.6%) received cefiderocol-containing regimens, 26 (7.6%) received colistin-containing regimens, and 37 (10.8%) received other active antibiotics. On multivariable analysis, septic shock (aHR, 3.57 [95% CI, 2.05\u20136.23]; P &lt; .001) and age (1.05 [1.03\u20131.08]; P &lt; .001) were independently associated with the 30-day mortality rate, while in vitro active antibiotic therapy within 48\u2005hours after infection (0.48 [.26\u2013.8]; P = .007) and source control (0.43 [.26\u2013.72]; P = .001) were protective factors. Sensitivity analysis showed that ceftazidime-avibactam plus aztreonam, compared with colistin, was independently associated with a reduced 30-day mortality rate (aHR, 0.39 [95% CI, .18\u2013.86]; P = .02). Propensity score analyses confirmed these findings.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n MBL-producing carbapenem-resistant Enterobacterales infections are associated with high 30-day mortality rates. Patients with MBL-producing Enterobacterales infections should receive early active antibiotic therapy.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/cid\/ciad725","type":"journal-article","created":{"date-parts":[[2023,12,1]],"date-time":"2023-12-01T03:47:33Z","timestamp":1701402453000},"page":"1111-1119","source":"Crossref","is-referenced-by-count":80,"title":["Clinical Features and Outcomes of Infections Caused by Metallo-\u03b2-Lactamase\u2013Producing Enterobacterales: A 3-Year Prospective Study From an Endemic Area"],"prefix":"10.1093","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3813-8796","authenticated-orcid":false,"given":"Marco","family":"Falcone","sequence":"first","affiliation":[{"name":"Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa , Pisa , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesira","family":"Giordano","sequence":"additional","affiliation":[{"name":"Microbiology Unit, Azienda Ospedaliero Universitaria Pisana , Pisa , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Leonildi","sequence":"additional","affiliation":[{"name":"Microbiology Unit, Azienda Ospedaliero Universitaria Pisana , Pisa , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Galfo","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa , Pisa , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurelio","family":"Lepore","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa , Pisa , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo Roberto","family":"Suardi","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa , Pisa , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niccol\u00f2","family":"Riccardi","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa , Pisa , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Barnini","sequence":"additional","affiliation":[{"name":"Microbiology Unit, Azienda Ospedaliero Universitaria Pisana , Pisa , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3884-4933","authenticated-orcid":false,"given":"Giusy","family":"Tiseo","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa , Pisa , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,11,30]]},"reference":[{"key":"2024070216454562300_ciad725-B1","doi-asserted-by":"crossref","first-page":"1776","DOI":"10.1093\/cid\/ciaa122","article-title":"Carbapenem-resistant Enterobacterales, carbapenem resistant organisms, carbapenemase-producing Enterobacterales, and carbapenemase-producing organisms: terminology past its \u201csell-by date\u201d in an era of new antibiotics and regional carbapenemase epidemiology","volume":"71","author":"Livermore","year":"2020","journal-title":"Clin Infect 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