# Management of infections caused by carbapenemase-producing Enterobacterales in France: a real-world study

## TL;DR

This study examines how CPE infections are managed in French hospitals, highlighting high mortality and the need for better diagnostics and treatment strategies.

## Contribution

A multicenter observational study in France provides real-world insights into CPE infection management and treatment practices.

## Key findings

- OXA-48-like and NDM carbapenemases were the most common pathogens in CPE infections.
- Empirical therapy was frequently inappropriate, especially for NDM infections.
- Patient factors and septic shock, not treatment timing, were key predictors of mortality.

## Abstract

Carbapenemase-producing Enterobacterales (CPE) are a significant public health concern, with limited treatment options and high mortality rates. The epidemiology and management of CPE infections in France remain insufficiently documented.

To provide a multicentre snapshot of the management of CPE infections in France, assess current clinical practices and evaluate their alignment with international guidelines.

We conducted a multicenter, observational, cross-sectional study across 31 French hospitals between September 2021 and March 2023. Adult patients with confirmed CPE infections were included. Clinical and microbiological data were collected retrospectively. Treatment regimens were analysed, and therapeutic appropriateness was assessed based on European and international guidelines.

Among 6936 screened patients, 96 met the inclusion criteria. The most frequently isolated pathogens were Klebsiella pneumoniae (42%), Escherichia coli (18%) and Enterobacter cloacae complex (16%). OXA-48-like carbapenemases were predominant (50%), followed by New Delhi metallo-β-lactamase (NDM) (38%). Initial empirical therapy was administered in 92.7% of patients overall; appropriateness was 50% in OXA-48-like infections and 25.5% in NDM infections. On multivariable analysis, 30-day mortality (34%) was associated with comorbidity burden and septic shock, whereas neither time to appropriate therapy nor therapy appropriateness independently predicted death. These data suggest outcomes were mainly driven by patient factors and severity, despite low empirical appropriateness—particularly for NDM—which supports efforts to improve early targeting through rapid diagnostics.

This study highlights the challenges associated with CPE infections, including high mortality and frequent inappropriate empirical therapy. Our findings emphasize the need for optimized antimicrobial stewardship and rapid microbiological diagnostics to improve patient outcomes.