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Introduction Carbapenem-resistant Enterobacterales (CRE) infections have high mortality. We aimed to examine the diabetes mellitus (DM) association with CRE mortality. Methodology Our study is a retrospective cohort study including patients who were admitted to the medical wards in the main district hospital (New Jahra Hospital, Kuwait) between January 1, 2022, and January 1, 2023, and diagnosed with CRE infections during hospitalization. The patients were divided into diabetic and non-diabetic groups. Clinical and laboratory data were collected. The presence of carbapenemase genes was detected. The primary outcome was 30-day hospital mortality. We assessed the effect of glycemic control on the outcomes. Results We included 47 patients in the diabetic group and 39 patients in the non-diabetic group. Females represented 54.7% of patients, and the median age was 73 and 55 years in the two groups, respectively. Klebsiella pneumonia (86%) and Escherichia coli (12.8%) were the most frequently isolated CRE. Carbapenemase genes were detected in all patients: NDM-1 in 67.4%, OXA-48 in 18.6%, and both genes coexisted in 14%. The 30-day hospital mortality was significantly higher in the diabetic group compared to the non-diabetic group (48.9% vs. 28.2%, P = 0.041). Among the diabetic patients, there was no significant difference between survivors and non-survivors regarding median glucose or glycated hemoglobin (HbA1c) levels (P = 0.465 and 0.932, respectively). Moreover, levels of glucose (odds ratio (OR) 0.928, confidence interval (CI) 0.763-1.13, P = 0.457) and HbA1c (OR 0.89, CI 0.63-1.26, P = 0.507) were not risk factors for increased mortality among diabetic patients. Conclusion We demonstrated the association between DM and increased CRE mortality regardless of the level of glycemic control. This study demonstrates the interaction between communicable and non-communicable diseases.
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We sought to assess pre-vaccination and post-vaccination seroprevalences of anti-SARS-CoV-2 antibodies in Kuwait and to compare antibody levels between vaccine types. In phase 1 (pre-vaccination period, n = 19,363), blood samples were collected before the launch of COVID-19 vaccination in Kuwait between 1 September and 31 December 2020. Blood samples for phase 2 (post-vaccination period, n = 4973) were collected between 1 September and 30 November 2021. We tested subjects for anti-SARS-CoV-2 antibodies using the DiaSorin LIAISON® SARS-CoV-2 IgM and Trimeric S IgG tests. In the pre-vaccination period, the prevalence of SARS-CoV-2 IgM and IgG was 14.50% (95% CI: 14.01-15.00) and 24.89% (95% CI: 24.29-25.50), respectively. The trend of seropositivity increased with age and was higher for females and non-Kuwaiti participants (p < 0.0001). Interestingly, seroprevalence was significantly higher for those who had received one dose of BNT162b2 (95.21%) than those who had received one dose of ChAdOx1-nCov-19 (92.86%). In addition, those who reported receiving two doses had higher seroprevalence, 96.25%, 95.86%, and 94.93% for ChA-dOx1-nCov-19/AstraZeneca, mix-and-match, and BNT162b2 recipients, respectively. After the second dose, median spike-specific responses showed no significant difference between ChAdOx1-nCov-19 and BNT162b2. Furthermore, statistical analysis showed no significant difference between median anti-trimeric S antibody levels of vaccinated individuals according to sex, age, or nationality (p > 0.05). In contrast, a negative correlation between age and anti-trimeric S IgG titers of BNT162b2-vaccinated subjects was observed (r = -0.062, p = 0.0009). Antibody levels decreased with time after vaccination with both vaccines. Our findings indicate that seroprevalence was very low during the pre-vaccination period (25%) in the general population and was greater than 95% in the vaccinated population in Kuwait. Furthermore, ChAdOx1-nCov-19 and BNT162b2 are effective in generating a similar humoral response.
