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Huang W, Qiao F, Deng Y, Zhu S, Li J, Zong Z, Zhang W. Analysis of risk factors associated with healthcare-associated carbapenem-resistant Klebsiella pneumoniae infection in a large general hospital: a case-case-control study. Eur J Clin Microbiol Infect Dis 2023; 42:529-541. [PMID: 36856898 PMCID: PMC9975449 DOI: 10.1007/s10096-023-04578-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/16/2023] [Indexed: 03/02/2023]
Abstract
Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection is a major public health threat in the world. To inform the prevention and control of CRKP infection in hospitals, this study analyzed the factors associated with CRKP infection and resistance to carbapenems in K. pneumoniae. This case-case-control study was carried out in a large general hospital in China from January 2016 to December 2018, comprising 494 hospitalized patients infected with CRKP (case group 1) and 2429 hospitalized patients infected with carbapenem-susceptible K. pneumoniae (CSKP, case group 2). We selected control groups from hospitalized patients without K. pneumoniae infections for the two case groups separately, with a 1:3 case-control ratio, to analyze the risk factors of the two case groups using the conditional logistic regression. Multivariate analysis showed that the risk factors of CRKP infection were intensive care unit (ICU) admission (odds ratio [OR], 6.85; 95% confidence interval [CI], 4.90-9.58; P < 0.001), respiratory failure (OR, 1.93; 95% CI, 1.34-2.77; P < 0.001), age-adjusted Charlson comorbidity index (aCCI; OR, 1.08; 95% CI, 1.02-1.15; P = 0.007), admission from the Emergency (OR, 1.37; 95% CI, 1.02-1.85; P = 0.036), and imipenem use (OR, 1.80; 95% CI, 1.30-2.49; P < 0.001). Among the aforementioned five risk factors, aCCI (OR, 1.09; 95% CI, 1.06-1.13; P < 0.001) was also identified as a risk factor of CSKP infections in multivariate analysis. The risk factors for resistance to carbapenems in K. pneumoniae were ICU admission, respiratory failure, admission from the Emergency, and imipenem use.
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Affiliation(s)
- Wenzhi Huang
- grid.412901.f0000 0004 1770 1022Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan China ,grid.412901.f0000 0004 1770 1022Department of Infection Control, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Fu Qiao
- grid.412901.f0000 0004 1770 1022Department of Infection Control, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Yuhua Deng
- grid.412901.f0000 0004 1770 1022Department of Infection Control, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Shichao Zhu
- grid.412901.f0000 0004 1770 1022Department of Infection Control, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Jingwen Li
- grid.412901.f0000 0004 1770 1022Department of Infection Control, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Zhiyong Zong
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Wei Zhang
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China. .,West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Abstract
PURPOSE OF REVIEW Skin and soft tissue infections (SSTIs) are a leading cause of morbidity, emergency department visits and hospitalization. In recent years, the spread of carbapenem-resistant gram-negative bacteria (GNB) is also increasing in SSTIs. However, the armamentarium of available drugs is recently expanding as well. In this review, we reported the most recent data and about management and treatment of SSTIs caused by GNB, mainly for the treatment of carbapenem-resistant Enterobacterales (CRE), Pseudomonas spp and Acinetobacter spp. RECENT FINDINGS The increasing incidence of carbapenem-resistant GNB is challenging for management and treatment, considering the high rate of inappropriate empiric and targeted antimicrobial treatments. The role of new antibiotics, mainly licensed for the treatment of other infections, is an object of continuous debate. As a matter of fact, no specific clinical trials on SSTIs have been performed for new drugs; however, recent data about the use in real life of new compounds in clinical practice are available. SUMMARY Some recently approved drugs are actually considered the backbone of targeted therapy in patients with severe infections caused by susceptible carbapenem-resistant GNB strains. Prompt diagnosis of cSSTIs is crucial and, when necessary, surgical debridement for source control of infection is the milestone of the treatment. The physicians should be confident to identify patients at high risk for multidrug-resistant pathogens to minimize inappropriate empiric therapy.
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Risk factors for infection and mortality caused by carbapenem-resistant Klebsiella pneumoniae: a large multicentre case-control and cohort study. J Infect 2022; 84:637-647. [PMID: 35301013 DOI: 10.1016/j.jinf.2022.03.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/09/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To elucidate the predictors of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection and help clinicians better identify CRKP infection at an early age. METHODS We conducted a multicentre case-control study of 422 patients with CRKP infection and 948 with carbapenem-susceptible K. pneumoniae (CSKP) infection from March to July 2017. Binary logistic regression was used to identify risk factors for CRKP infection. The subgroups of CRKP respiratory infection, intra-abdominal infection, and bloodstream infection were also evaluated. Patients were followed up for 28 days. Independent risk factors for 28-day crude mortality of CRKP infection were analysed using Cox proportional hazards regression models. RESULTS Longer stay of hospitalization, stay in the ICU, previous exposure to antibacterial agents (especially carbapenems, quinolones, aminoglycosides, and tigecycline), invasive procedures, intravascular catheter use, tracheotomy, or admission to ICU in the preceding 90 days were risk factors for CRKP infection. Carbapenem exposure was the only common predictor of different types of CRKP infection. The 28-day mortality of CRKP infection was 13.1% and was independently associated with sex, admitted unit, and types of infection. CONCLUSIONS Strict policies for antibiotic use, cautious decisions regarding the implementation of invasive procedures, and careful management of patients with catheters, especially intravascular catheters, are necessary to handle CRKP infection.
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Arzilli G, Scardina G, Casigliani V, Petri D, Porretta A, Moi M, Lucenteforte E, Rello J, Lopalco P, Baggiani A, Privitera GP, Tavoschi L. Screening for Antimicrobial-Resistant Gram-negative bacteria in hospitalised patients, and risk of progression from colonisation to infection: Systematic review. J Infect 2021; 84:119-130. [PMID: 34793762 DOI: 10.1016/j.jinf.2021.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 10/26/2021] [Accepted: 11/10/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Transmission of antimicrobial-resistant Gram-negative bacteria (AMR-GNB) among hospitalised patients can lead to new cases of carriage, infection and outbreaks, hence the need for early carrier identification. We aim to explore two key elements that may guide control policies for colonisation/infection in hospital settings: screening practices on admission to hospital wards and risk of developing infection from colonisation. METHODS We searched on PubMed, Scopus and Cochrane databases for studies published from 2010 up to 2021 reporting on adult patients hospitalised in high-income countries. RESULTS The search retrieved 11853 articles. After screening, 100 studies were included. Combining target patient groups and setting type, we identified six screening approaches. The most reported approach was all admitted patients to high-risk (HR) wards (49.4%). The overall prevalence of AMR-GNB was 13.8% (95%CI 9.3-19.0) with significant differences across regions and time. Risk of progression to infection among colonised patients was 11.0% (95%CI 8.0-14.3) and varied according to setting and pathogens' group (p value<0.0001), with higher values reported for Klebsiella species (18.1%; 95%CI 8.9-29.3). CONCLUSIONS While providing a comprehensive overview of the screening approaches, our study underlines the considerable burden of AMR-GNB colonisation and risk of progression to infection in hospitals by pathogen, setting and time.
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Affiliation(s)
- Guglielmo Arzilli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56123, Italy
| | - Giuditta Scardina
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56123, Italy
| | - Virginia Casigliani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56123, Italy
| | - Davide Petri
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56123, Italy
| | - Andrea Porretta
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56123, Italy; University Hospital of Pisa, Pisa 56123, Italy.
| | - Marco Moi
- Department of Surgical Sciences, University of Cagliari, Cagliari 09124, Italy
| | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56123, Italy
| | - Jordi Rello
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Clinical Research/epidemiology In Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain; Clinical Research, CHU Nîmes, Nîmes, France
| | - Pierluigi Lopalco
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56123, Italy
| | - Angelo Baggiani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56123, Italy; University Hospital of Pisa, Pisa 56123, Italy
| | - Gaetano Pierpaolo Privitera
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56123, Italy; University Hospital of Pisa, Pisa 56123, Italy
| | - Lara Tavoschi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56123, Italy
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Dumitru IM, Dumitrascu M, Vlad ND, Cernat RC, Ilie-Serban C, Hangan A, Slujitoru RE, Gherghina A, Mitroi-Maxim C, Curtali L, Carp DS, Dumitrescu A, Mitan R, Lesanu R, Rugina S. Carbapenem-Resistant Klebsiella pneumoniae Associated with COVID-19. Antibiotics (Basel) 2021; 10:561. [PMID: 34065029 PMCID: PMC8151469 DOI: 10.3390/antibiotics10050561] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/26/2021] [Accepted: 05/10/2021] [Indexed: 02/07/2023] Open
Abstract
Infections with carbapenem-resistant Enterobacteriaceae are emerging as an important challenge in healthcare settings. Currently, carbapenem-resistant Klebsiella pneumoniae (CRKP) are the species of CRE most commonly encountered in hospitals. CRKP is resistant to almost all available antimicrobial agents, and infections with CRKP have been associated with high rates of morbidity and mortality, particularly among persons with prolonged hospitalization exposed to invasive devices. We report nine patients hospitalized in an intensive care unit (ICU) with severe coronavirus disease 2019 (COVID-19) who developed invasive infections due to carbapenemase-producing Klebsiella pneumoniae (CP-Kp), KPC and OXA-48, strains that have not been previously identified in our hospital. Despite ceftazidime/avibactam therapy, five patients died. Coinfections can contribute to a poor prognosis for patients with COVID-19, especially for high-risk populations such as elderly patients. Therefore, it is crucial to establish a rigorous program of antibiotic administration in intensive care units.
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Affiliation(s)
- Irina Magdalena Dumitru
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
- Faculty of Medicine, Ovidius University of Constanta, Aleea Universității, nr. 1, 900470 Constanta, Romania
- Doctoral School of Medicine, Ovidius University of Constanta, Aleea Universității nr. 1, 900470 Constanta, Romania
| | - Mirela Dumitrascu
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
| | - Nicoleta Dorina Vlad
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
- Doctoral School of Medicine, Ovidius University of Constanta, Aleea Universității nr. 1, 900470 Constanta, Romania
| | - Roxana Carmen Cernat
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
- Faculty of Medicine, Ovidius University of Constanta, Aleea Universității, nr. 1, 900470 Constanta, Romania
| | - Carmen Ilie-Serban
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
| | - Aurelia Hangan
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
- Faculty of Medicine, Ovidius University of Constanta, Aleea Universității, nr. 1, 900470 Constanta, Romania
| | - Raluca Elena Slujitoru
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
| | - Aura Gherghina
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
| | - Corina Mitroi-Maxim
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
| | - Licdan Curtali
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
| | - Dalia Sorina Carp
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
| | - Anca Dumitrescu
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
| | - Romelia Mitan
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
| | - Rodica Lesanu
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
| | - Sorin Rugina
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
- Faculty of Medicine, Ovidius University of Constanta, Aleea Universității, nr. 1, 900470 Constanta, Romania
- Doctoral School of Medicine, Ovidius University of Constanta, Aleea Universității nr. 1, 900470 Constanta, Romania
- Romanian Academy of Scientists, Spl. Independentei 54, 030167 București, Romania
- Romanian Academy of Medical Sciences, Bulevardul Ion C. Brătianu 1, 030167 București, Romania
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Avendano EE, Raman G, Chan J, McCann E. Burden of carbapenem non-susceptible infections in high-risk patients: systematic literature review and meta-analysis. Antimicrob Resist Infect Control 2020; 9:193. [PMID: 33287894 PMCID: PMC7720068 DOI: 10.1186/s13756-020-00858-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/18/2020] [Indexed: 01/02/2023] Open
Abstract
Background Owing to their resistance to an important class of antibiotics, the prevention and treatment of carbapenem-resistant (CR)/non-susceptible Gram-negative (GN) infections has become an important public health objective. We conducted a systematic review and meta-analysis of published literature to evaluate the burden of CR GN infections, focusing on high-risk patients such as transplant recipients, or patients with cancer, renal impairment, or sepsis.
Methods MEDLINE®, Cochrane Central, and Embase® were searched between 2010 and March 2019. Abstracts and full-text articles were screened in duplicate. Random effects meta-analysis was conducted when reported outcomes were sufficiently similar.
Results Twenty-six publications were eligible. Meta-analyses found increased mortality associated with CR infections among high-risk patients in both unadjusted analysis (8 studies; summary unadjusted odds ratio [OR]: 5.85; 95% confidence interval [CI]: 3.69, 9.26; I2 = 19.8%) and adjusted analysis (5 studies; summary hazard ratio [HR]: 4.67; 95% CI: 2.18, 9.99; I2 = 77.7%), compared to patients with carbapenem-susceptible (CS) infections or no infection. Increased mortality was also seen in subgroup analyses by length of follow-up (either short-term or long-term) or causative pathogen. A limited number of studies found that CR GN infections increased the risk for mechanical ventilation, adverse events such as graft failure or acute rejection in solid organ transplant recipients, increased renal failure or nephrotoxicity, and an increase in readmissions and costs, though the findings reported in the literature were not consistent. Conclusion This systematic literature review and meta-analysis indicates that CR GN infections in high-risk patients are associated with increased mortality, emphasizing the need for antimicrobial stewardship and infection control in hospitals which treat high-risk patients and for the development of effective antimicrobials with favorable efficacy and safety profiles for the treatment of CR GN infections.
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Affiliation(s)
- Esther E Avendano
- Institute for Clinical Research and Health Policy Studies, Center for Clinical Evidence Synthesis, Tufts Medical Center, Boston, MA, USA.
| | - Gowri Raman
- Institute for Clinical Research and Health Policy Studies, Center for Clinical Evidence Synthesis, Tufts Medical Center, Boston, MA, USA.,Tufts University School of Medicine, Boston, MA, USA
| | - Jeffrey Chan
- Institute for Clinical Research and Health Policy Studies, Center for Clinical Evidence Synthesis, Tufts Medical Center, Boston, MA, USA
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Giacobbe DR, Salsano A, Del Puente F, Miette A, Vena A, Corcione S, Bartoletti M, Mularoni A, Maraolo AE, Peghin M, Carnelutti A, Losito AR, Raffaelli F, Gentile I, Maccari B, Frisone S, Pascale R, Mikus E, Medaglia AA, Conoscenti E, Ricci D, Lupia T, Comaschi M, Giannella M, Tumbarello M, De Rosa FG, Del Bono V, Mikulska M, Santini F, Bassetti M. Risk Factors for Candidemia After Open Heart Surgery: Results From a Multicenter Case-Control Study. Open Forum Infect Dis 2020; 7:ofaa233. [PMID: 32766378 PMCID: PMC7397829 DOI: 10.1093/ofid/ofaa233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/11/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Candida species are among the most frequent causative agents of health care-associated bloodstream infections, with mortality >40% in critically ill patients. Specific populations of critically ill patients may present peculiar risk factors related to their reason for intensive care unit admission. The primary objective of the present study was to assess the predictors of candidemia after open heart surgery. METHODS This retrospective, matched case-control study was conducted in 8 Italian hospitals from 2009 to 2016. The primary study objective was to assess factors associated with the development of candidemia after open heart surgery. RESULTS Overall, 222 patients (74 cases and 148 controls) were included in the study. Candidemia developed at a median time (interquartile range) of 23 (14-36) days after surgery. In multivariable analysis, independent predictors of candidemia were New York Heart Association class III or IV (odds ratio [OR], 23.81; 95% CI, 5.73-98.95; P < .001), previous therapy with carbapenems (OR, 8.87; 95% CI, 2.57-30.67; P = .001), and previous therapy with fluoroquinolones (OR, 5.73; 95% CI, 1.61-20.41; P = .007). Crude 30-day mortality of candidemia was 53% (39/74). Septic shock was independently associated with mortality in the multivariable model (OR, 5.64; 95% CI, 1.91-16.63; P = .002). No association between prolonged cardiopulmonary bypass time and candidemia was observed in this study. CONCLUSIONS Previous broad-spectrum antibiotic therapy and high NYHA class were independent predictors of candidemia in cardiac surgery patients with prolonged postoperative intensive care unit stay.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Antonio Salsano
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
- Division of Cardiac Surgery, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Filippo Del Puente
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Ambra Miette
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
- Division of Cardiac Surgery, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Antonio Vena
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Michele Bartoletti
- Department of Medical and Surgical Sciences, Infectious Diseases Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | | | - Alberto Enrico Maraolo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maddalena Peghin
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Alessia Carnelutti
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Angela Raffaella Losito
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Raffaelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ivan Gentile
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | | | - Renato Pascale
- Department of Medical and Surgical Sciences, Infectious Diseases Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Elisa Mikus
- Maria Cecilia Hospital - GVM Care & Research, Cotignola, Italy
| | | | | | - Davide Ricci
- Division of Cardiac Surgery, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Tommaso Lupia
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | | | - Maddalena Giannella
- Department of Medical and Surgical Sciences, Infectious Diseases Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Mario Tumbarello
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Valerio Del Bono
- Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Malgorzata Mikulska
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Francesco Santini
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
- Division of Cardiac Surgery, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
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Zhu WM, Yuan Z, Zhou HY. Risk factors for carbapenem-resistant Klebsiella pneumoniae infection relative to two types of control patients: a systematic review and meta-analysis. Antimicrob Resist Infect Control 2020; 9:23. [PMID: 32005246 PMCID: PMC6995231 DOI: 10.1186/s13756-020-0686-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 01/23/2020] [Indexed: 01/11/2023] Open
Abstract
Background Studies on risk factors for carbapenem-resistant Klebsiella pneumoniae (CRKP) infection have provided inconsistent results, partly due to the choice of the control group. We conducted a systematic review and meta-analysis to assess the risk factors for CRKP infection by comparing CRKP-infected patients with two types of controls: patients infected with carbapenem-susceptible Klebsiella pneumoniae (comparison 1) or patients not infected with CRKP (comparison 2). Methods Data on potentially relevant risk factors for CRKP infection were extracted from studies indexed in PubMed, EMBASE, Web of Science or EBSCO databases from January 1996 to April 2019, and meta-analyzed based on the outcomes for each type of comparison. Results The meta-analysis included 18 studies for comparison 1 and 14 studies for comparison 2. The following eight risk factors were common to both comparisons: admission to intensive care unit (ICU; odds ratio, ORcomparison 1 = 3.20, ORcomparison 2 = 4.44), central venous catheter use (2.62, 3.85), mechanical ventilation (2.70, 4.78), tracheostomy (2.11, 8.48), urinary catheter use (1.99, 0.27), prior use of antibiotic (6.07, 1.61), exposure to carbapenems (4.16, 3.84) and exposure to aminoglycosides (1.85, 1.80). Another 10 risk factors were unique to comparison 1: longer length of hospital stay (OR = 15.28); prior hospitalization (within the previous 6 months) (OR = 1.91); renal dysfunction (OR = 2.17); neurological disorders (OR = 1.52); nasogastric tube use (OR = 2.62); dialysis (OR = 3.56); and exposure to quinolones (OR = 2.11), fluoroquinolones (OR = 2.03), glycopeptides (OR = 3.70) and vancomycin (OR = 2.82). Conclusions Eighteen factors may increase the risk of carbapenem resistance in K. pneumoniae infection; eight factors may be associated with both K. pneumoniae infections in general and CRKP in particular. The eight shared factors are likely to be ‘true’ risk factors for CRKP infection. Evaluation of risk factors in different situations may be helpful for empirical treatment and prevention of CRKP infections.
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Affiliation(s)
- Wei-Min Zhu
- Division of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, No. 1 You Yi Road, Yuan Jia Gang, Yuzhong District, Chongqing, 400016, China
| | - Zhe Yuan
- Division of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, No. 1 You Yi Road, Yuan Jia Gang, Yuzhong District, Chongqing, 400016, China.,Department of Hospital Infection Control, The First Affiliated Hospital of Chongqing Medical University, No. 1 You Yi Road, Yuan Jia Gang, Yuzhong District, Chongqing, 400016, China
| | - Hong-Yu Zhou
- Department of Hospital Infection Control, The First Affiliated Hospital of Chongqing Medical University, No. 1 You Yi Road, Yuan Jia Gang, Yuzhong District, Chongqing, 400016, China.
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9
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Del Puente F, Giacobbe DR, Salsano A, Maraolo AE, Ong DSY, Yusuf E, Tutino S, Marchese A, Santini F, Viscoli C. Epidemiology and outcome of Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae (KPC-KP) infections in cardiac surgery patients: a brief narrative review. J Chemother 2019; 31:359-366. [PMID: 31701842 DOI: 10.1080/1120009x.2019.1685794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae (KPC-KP) is a difficult-to-treat pathogen due to its multidrug-resistant phenotype. Cardiac surgery patients are at increased risk of developing KPC-KP infections compared to other populations, with previous KPC-KP colonization being a critical factor in influencing the risk of subsequent infection. Two different pieces of information are essential to comprehensively assess the local characteristics of KPC-KP colonization in cardiac surgery patients: (i) the local prevalence of colonization; (ii) the timing of colonization. Treatment of KPC-KP infections in cardiac surgery patients is a complex task, but more effective treatment options have recently become available. Nonetheless, implementation and full adherence to infection-control measures remain of pivotal importance for reducing the burden of KPC-KP infections in this peculiar population. The aim of this narrative review is to summarize the available literature on the epidemiology and outcome of KPC-KP infections in cardiac surgery patients.
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Affiliation(s)
- Filippo Del Puente
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Daniele R Giacobbe
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Antonio Salsano
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa, Genoa, Italy.,Division of Cardiac Surgery, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Alberto E Maraolo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.,Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Erlangga Yusuf
- Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Stefania Tutino
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Anna Marchese
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa, Genoa, Italy.,Microbiology Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Francesco Santini
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa, Genoa, Italy.,Division of Cardiac Surgery, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Claudio Viscoli
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
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10
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Association between carbapenem-resistant Enterobacteriaceae and death: A systematic review and meta-analysis. Am J Infect Control 2019; 47:1200-1212. [PMID: 31072673 DOI: 10.1016/j.ajic.2019.03.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/16/2019] [Accepted: 03/17/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Carbapenem-resistant Enterobacteriaceae (CRE) has emerged in health care facilities around the world. Several studies demonstrated data regarding clinical outcomes for CRE infections including death. This systematic review and meta-analysis summarized literature discussing association between CRE and mortality. METHODS A systematic literature review was performed by searching EMBASE, International Pharmaceutical Abstract databases, PubMed, and Scopus and to identify studies that assessed the association between CRE and death published from April 2012 to October 2017. A meta-analysis was performed using a random effect model. Heterogeneity was assessed using the I2-statistic. RESULTS Twenty-one studies were included in this meta-analysis. The underlying populations were moderately heterogeneous (I2 = 60%; P = .01). Pooled risk estimates from 9 studies revealed a significant association between CRE and death (pooled-adjusted odds ratio: 2.85; 95% confidence interval: 1.88, 4.30). The unadjusted variable pooled from 18 studies demonstrated a significant association between CRE and death (pooled-unadjusted odds ratio: 3.73; 95% confidence interval: 2.02, 6.88). DISCUSSION The finding that CRE infection was positively associated with death agreed with the previous meta-analysis of studies published before April 2012. CONCLUSIONS This meta-analysis found that CRE was associated with increased risk of death. Our analysis implies a need for strict infection control measures.
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11
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Reduced Incidence of Carbapenem-Resistant Klebsiella pneumoniae Infections in Cardiac Surgery Patients after Implementation of an Antimicrobial Stewardship Project. Antibiotics (Basel) 2019; 8:antibiotics8030132. [PMID: 31466372 PMCID: PMC6783823 DOI: 10.3390/antibiotics8030132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 08/23/2019] [Accepted: 08/26/2019] [Indexed: 12/15/2022] Open
Abstract
Infections due to carbapenem-resistant Klebsiella pneumoniae (CR-Kp) are associated with increased mortality in cardiac surgery patients. In this short communication, we report on the changes in the incidence of CR-Kp colonization and CR-Kp infection in cardiac surgery patients from 2014 to 2018 in a teaching hospital in Italy, after the implementation of an antimicrobial stewardship project in 2014. During the study period, 2261 patients underwent open-heart surgery. Of them, 130 were found to be colonized by CR-Kp (5.7%) and 52 developed a postoperative CR-Kp infection (2.3%). The crude in-hospital mortality in patients with CR-Kp infections was 48% (25/52). The incidences of both CR-Kp colonization (incidence rate ratio (IRR) 0.82, 95% confidence intervals (CI) 0.78-0.86, p < 0.001) and CR-Kp infection (IRR 0.76, 95% CI 0.69-0.83, p < 0.001) considerably decreased over the study period. This encouraging result should prompt further concerted efforts, directed towards retaining the positive impact of stewardship and infection-control interventions on CR-Kp-related morbidity in the long term.
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12
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Giannella M, Pascale R, Gutiérrez-Gutiérrez B, Cano A, Viale P. The use of predictive scores in the management of patients with carbapenem-resistant Klebsiella pneumoniae infection. Expert Rev Anti Infect Ther 2019; 17:265-273. [PMID: 30876375 DOI: 10.1080/14787210.2019.1595590] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Carbapenem-resistant Klebsiella pneumoniae (CR-KP) infections are associated with high morbidity and mortality rates. A therapeutic approach based on the patient risk stratification could improve outcome and avoid antibiotic misuse. Areas covered: English literature search, from 2008 to 2018, was done using PubMed database. Risk factors for developing CR-KP infection in several settings were reviewed. Since, rectal carriage was a main risk factor for developing infection, we revised in deep clinical score to predict infection among colonized patients. Furthermore, we investigated overall and treatment-related risk factors for poor outcome in patients with CR-KP infection, in particular the carbapenem producing Enterobacteriacieae (CPE)-INCREMENT score. Finally, an algorithm, based on such scores, for the therapeutic management of patients with CR-KP colonization was commented. Expert opinion: The therapeutic approach analyzed in this review could help physicians to avoid antibiotic overuse as well as to start promptly with the most appropriate antibiotic regimen. However, it has to be validated in further studies, mainly among special population such as immunocompromised patients. The availability of new drugs, fast microbiology, and analysis of gut microbiome could significantly improve the management of CR-KP colonized and/or infected patients.
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Affiliation(s)
- Maddalena Giannella
- a Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi , University of Bologna , Bologna , Italy
| | - Renato Pascale
- a Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi , University of Bologna , Bologna , Italy
| | - Belén Gutiérrez-Gutiérrez
- b Infectious Diseases Unit, Hospital Universitario Virgen Macarena-Instituto de Biomedicina de Sevilla (IBiS) and Department of Medicine , Universidad de Sevilla , Sevilla , Spain
| | - Angela Cano
- c Infectious Diseases Unit , Hospital Univesritario Reina Sofia-Instituto Maimonides de Investigacion Biomedica de Cordoba (IMIBIC)-Unversidad de Cordoba , Cordoba , Spain
| | - Pierluigi Viale
- a Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi , University of Bologna , Bologna , Italy
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13
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Giacobbe DR, Corcione S, Salsano A, Del Puente F, Mornese Pinna S, De Rosa FG, Mikulska M, Santini F, Viscoli C. Current and emerging pharmacotherapy for the treatment of infections following open-heart surgery. Expert Opin Pharmacother 2019; 20:751-772. [PMID: 30785333 DOI: 10.1080/14656566.2019.1574753] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Patients undergoing open-heart surgery may suffer from postoperative complications, including severe infections. Antimicrobials to treat infectious complications in this population should be selected thoughtfully, taking into account three different and fundamental issues: (i) the site of infection; (ii) the suspected or proven causative agent and its susceptibility pattern; and (iii) the risk of suboptimal pharmacokinetic characteristics and potential toxicity of the chosen drug/s. AREAS COVERED The present narrative review summarizes the current and future antimicrobial options for the treatment of infections developing after open-heart surgery. EXPERT OPINION The pharmacological treatment of infections developing in cardiac surgery patients poses peculiar challenges, including the need for an active empirical therapy for severe events such as bloodstream infections, deep sternal wound infections, or early-onset postoperative prosthetic endocarditis. In addition, the risk for multidrug-resistant pathogens should also be taken into account in endemic areas. A multidisciplinary evaluation on a patient-by-patient basis, deeply involving infectious diseases specialists and cardiothoracic surgeons, remains essential for appropriately balancing both short-term and long-term risks and benefits of any possible surgical reintervention in combination with adequate pharmacotherapy.
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Affiliation(s)
| | - Silvia Corcione
- b Department of Medical Sciences, Infectious Diseases , University of Turin , Turin , Italy
| | - Antonio Salsano
- c Division of Cardiac Surgery, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC) , University of Genoa , Genoa , Italy.,d Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino , Genoa , Italy
| | - Filippo Del Puente
- a Dipartimento di Scienze della Salute (DISSAL) , University of Genoa , Genoa , Italy
| | - Simone Mornese Pinna
- b Department of Medical Sciences, Infectious Diseases , University of Turin , Turin , Italy
| | | | - Malgorzata Mikulska
- a Dipartimento di Scienze della Salute (DISSAL) , University of Genoa , Genoa , Italy.,d Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino , Genoa , Italy
| | - Francesco Santini
- c Division of Cardiac Surgery, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC) , University of Genoa , Genoa , Italy.,d Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino , Genoa , Italy
| | - Claudio Viscoli
- a Dipartimento di Scienze della Salute (DISSAL) , University of Genoa , Genoa , Italy.,d Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino , Genoa , Italy
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14
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Giacobbe DR, Mikulska M, Viscoli C. Recent advances in the pharmacological management of infections due to multidrug-resistant Gram-negative bacteria. Expert Rev Clin Pharmacol 2018; 11:1219-1236. [DOI: 10.1080/17512433.2018.1549487] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
| | - Malgorzata Mikulska
- Dipartimento di Scienze della Salute (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudio Viscoli
- Dipartimento di Scienze della Salute (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genoa, Italy
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15
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Erdem F, Oncul O, Aktas Z. Characterization of Resistance Genes and Polymerase Chain Reaction-Based Replicon Typing in Carbapenem-Resistant Klebsiella pneumoniae. Microb Drug Resist 2018; 25:551-557. [PMID: 30457928 DOI: 10.1089/mdr.2018.0231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Fifty isolates of Klebsiella pneumoniae isolated from clinical samples between 2012 and 2016 that were found to be resistant to carbapenems were included in this study. Materials and Methods: Resistance genes were investigated by performing PCR. Plasmid typing was performed using PCR-based replicon typing. The clonal relationships between the strains were investigated using pulsed-field gel electrophoresis (PFGE). Results: OXA-48-type carbapenemase genes were detected in 86% (n = 43/50) of K. pneumoniae isolates, whereas NDM-type carbapenemase genes were detected in 14% (n = 7/50) of the isolates. blaTEM was detected 60% (n = 30) of the strains, blaSHV in 78% (n = 39), blaCTX-M-1 in 48% (n = 24), and blaCTX-M-2-type β-lactamase in 10% (n = 5). blaCTX-M-1 and blaSHV were concomitantly distributed in 40% (n = 20) of the strains, blaTEM and blaSHV in 54% (n = 27), blaTEM, blaSHV, and blaCTX-M-1 in 32% (n = 16) and blaCTX-M-1 and blaCTX-M-2 in 10% (n = 5). Strain numbers 66, 69, 76, 77, and 78 coproduced carbapenemases, blaCTX-M-1 and blaCTX-M-2 in addition to blaOXA-48 or blaNDM-1 that were described as hybrid strains. IncR-type replicon was found in 50% (n = 25) of 50 isolates with plasmid typing, whereas IncA/C-type replicon was detected in 40% (n = 20) and IncFIIK-type replicon in 18% (n = 9) of the isolates. Outcomes of the transformation experiments showed that the OXA-48 gene was carried to the receiver cell on FII plasmids. No dominant epidemic clone was detected through PFGE. Conclusion: OXA-48 carbapenemase was found to be the most prevalent type of enzyme in our hospital, and the presence of NDM-1-type carbapenemase-carrying strain and an increase in their rate were detected.
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Affiliation(s)
- Fatma Erdem
- 1 Department of Medical Microbiology, Adana City Training and Research Hospital, Adana, Turkey
| | - Oral Oncul
- 2 Department of Infectious Diseases and Clinical Microbiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Zerrin Aktas
- 3 Department of Medical Microbiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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16
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Starzyk-Łuszcz K, Zielonka TM, Jakubik J, Życińska K. Mortality Due to Nosocomial Infection with Klebsiella pneumoniae ESBL<sup/>. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1022:19-26. [PMID: 28456930 DOI: 10.1007/5584_2017_38] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Klebsiella pneumoniae is one of the most important hospital pathogens, particularly concerning the multidrug-resistant strain ESBL+. The aim of this study was to evaluate nosocomial infections with K. pneumoniae ESBL+ in the context of infection location, risk factors, and prognosis. This hospital study was conducted retrospectively and covered a 3 months' period. The infection with K. pneumoniae ESBL+ was diagnosed in 36 patients (19 women and 17 men) of the mean age of 74.2 ± 14.8 years. The number of infected patients amounted to 2.2% of all patients admitted to Czerniakowski Hospital in Warsaw, Poland, over the study time. Twenty of these patients died (13 women and 7 men), representing 14% of all hospital deaths at the time. The infection with K. pneumoniae ESBL+ occurred most frequently in the department of internal diseases, and rarely in neurology or intensive care wards. Bacteria was most often isolated from the urine, with the most distinct association between the use of urinary catheters and death (p = 0.019). We conclude that infections with K. pneumoniae ESBL+ were associated with over 55% mortality and usually occurred in the setting of internal diseases. Deaths due to K. pneumoniae ESBL+ infection were significantly related to the use of urinary bladder catheters.
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Affiliation(s)
| | - Tadeusz M Zielonka
- Department of Family Medicine, Warsaw Medical University, 1A Banacha Street, 02-097, Warsaw, Poland.
| | - Joanna Jakubik
- Committee of Infection Control, Czerniakowski Hospital, Warsaw, Poland
| | - Katarzyna Życińska
- Department of Family Medicine, Warsaw Medical University, 1A Banacha Street, 02-097, Warsaw, Poland
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17
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Mestrovic T, Bedenic B. eComment. Diagnostic intricacies and fortuitous treatment approaches for carbapenem-resistant Klebsiella pneumoniae. Interact Cardiovasc Thorac Surg 2017; 23:768. [PMID: 27880707 DOI: 10.1093/icvts/ivw266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Tomislav Mestrovic
- Clinical Microbiology and Parasitology Unit, Polyclinic "Dr. Zora Profozic", Zagreb, Croatia
| | - Branka Bedenic
- Department of Clinical and Molecular Microbiology, University Hospital Centre Zagreb, Zagreb, Croatia
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18
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Giacobbe DR, Salsano A, Marchese A, Santini F. eReply. Diagnostic intricacies and fortuitous treatment approaches for carbapenem-resistant Klebsiella pneumoniae. Interact Cardiovasc Thorac Surg 2017; 23:768. [PMID: 27880708 DOI: 10.1093/icvts/ivw289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Daniele Roberto Giacobbe
- Division of Infectious Diseases, University of Genoa (DISSAL) and IRCCS San Martino-IST, Genoa, Italy
| | - Antonio Salsano
- Division of Cardiac Surgery, IRCCS San Martino-IST, Genoa, Italy
| | - Anna Marchese
- Microbiology Unit, University of Genoa (DISC) and IRCCS San Martino-IST, Genoa, Italy
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19
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Infection after open heart surgery in Golestan teaching hospital of Ahvaz, Iran. Data Brief 2017; 16:478-482. [PMID: 29255781 PMCID: PMC5725203 DOI: 10.1016/j.dib.2017.11.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/24/2017] [Accepted: 11/13/2017] [Indexed: 11/22/2022] Open
Abstract
The present study surveyed demographic and infection data which were obtained after open heart surgery (OHS) through patient's admission in Golestan teaching hospital, Ahvaz metropolitan city of Iran, taking into account the confirmed location of the infection, microorganism and antibiotic susceptibility. The occurrence of infection among patients during 48 to 72 h after surgery and hospital admission is the definition of Nosocomial infections (NIs) (Salmanzadeh et al., 2015) [1]. All of them after OHS were chosen for this study. In this paper, type of catheter, fever, type of microorganism, antibiotic susceptibility, location of the infection and outcome (live or death) were studied (Juhl et al., 2017; Salsano et al., 2017) [2], [3]. After the completion of the observations and recording patients' medical records, the coded data were fed into EXCELL. Data analysis was performed using SPSS 16.
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20
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Bassetti M, Giacobbe DR, Giamarellou H, Viscoli C, Daikos GL, Dimopoulos G, De Rosa FG, Giamarellos-Bourboulis EJ, Rossolini GM, Righi E, Karaiskos I, Tumbarello M, Nicolau DP, Viale PL, Poulakou G. Management of KPC-producing Klebsiella pneumoniae infections. Clin Microbiol Infect 2017; 24:133-144. [PMID: 28893689 DOI: 10.1016/j.cmi.2017.08.030] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/17/2017] [Accepted: 08/23/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-KP) has become one of the most important contemporary pathogens, especially in endemic areas. AIMS To provide practical suggestion for physicians dealing with the management of KPC-KP infections in critically ill patients, based on expert opinions. SOURCES PubMed search for relevant publications related to the management of KPC-KP infections. CONTENTS A panel of experts developed a list of 12 questions to be addressed. In view of the current lack of high-level evidence, they were asked to provide answers on the bases of their knowledge and experience in the field. The panel identified several key aspects to be addressed when dealing with KPC-KP in critically ill patients (preventing colonization in the patient, preventing infection in the colonized patient and colonization of his or her contacts, reducing mortality in the infected patient by rapidly diagnosing the causative agent and promptly adopting the best therapeutic strategy) and provided related suggestions that were based on the available observational literature and the experience of panel members. IMPLICATIONS Diagnostic technologies could speed up the diagnosis of KPC-KP infections. Combination treatment should be preferred to monotherapy in cases of severe infections. For non-critically ill patients without severe infections, results from randomized clinical trials are needed for ultimately weighing benefits and costs of using combinations rather than monotherapy. Multifaceted infection control interventions are needed to decrease the rates of colonization and cross-transmission of KPC-KP.
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Affiliation(s)
- M Bassetti
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy.
| | - D R Giacobbe
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, University of Genoa (DISSAL), Genoa, Italy
| | - H Giamarellou
- 6th Department of Internal Medicine, Hygeia General Hospital, 4, Erythrou Stavrou Str & Kifisias, Marousi, Athens, Greece
| | - C Viscoli
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, University of Genoa (DISSAL), Genoa, Italy
| | - G L Daikos
- 1st Department of Propaedeutic Medicine, Laikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - G Dimopoulos
- Department of Critical Care, University Hospital Attikon, Medical School, University of Athens, Athens, Greece
| | - F G De Rosa
- Department of Medical Science, University of Turin, Infectious Diseases Amedeo di Savoia Hospital, Turin, Italy
| | - E J Giamarellos-Bourboulis
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - G M Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - E Righi
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy
| | - I Karaiskos
- 6th Department of Internal Medicine, Hygeia General Hospital, 4, Erythrou Stavrou Str & Kifisias, Marousi, Athens, Greece
| | - M Tumbarello
- Institute of Infectious Diseases Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - D P Nicolau
- Center for Anti-infective Research and Development, Hartford, CT, USA; Division of Infectious Diseases, Hartford Hospital, Hartford, CT, USA
| | - P L Viale
- Clinic of Infectious Diseases, Department of Internal Medicine, Geriatrics and Nephrologic Diseases, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Poulakou
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy
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21
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Bartolini A, Basso M, Franchin E, Menegotto N, Ferrari A, De Canale E, Andreis S, Scaggiante R, Stefani S, Palù G, Parisi SG. Prevalence, molecular epidemiology and intra-hospital acquisition of Klebsiella pneumoniae strains producing carbapenemases in an Italian teaching hospital from January 2015 to September 2016. Int J Infect Dis 2017; 59:103-109. [PMID: 28412407 DOI: 10.1016/j.ijid.2017.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 04/04/2017] [Accepted: 04/05/2017] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES We described Klebsiella pneumoniae producing carbapenemase (CPKP) spread from 01/01/2015 to 13/09/16 in a tertiary level hospital. METHODS The first positive surveillance rectal swab (SRS) or clinical sample (CS) collected in the medical department (MD), surgical department (SD) and intensive care department (ICD) were included in the study. A validated in-house Real-Time PCR method was used to detect carbapenemases; multilocus sequence typing (MLST) was used for further characterization of the strains. RESULTS 21535 patients were included: 213 CPKP strains from surveillance rectal swab (SRS) and 98 from clinical samples (CS) were collected. The percentage of CPKP detected in SRS with respect to CS increased in the medical MD from 2015 to 2016 (p=0.01) and in ICD from 2012 to 2015 (p=0.0001), while it decreased in SD from 2014 to 2016 (p=0.003); 68.5% of the positive SRS had a previous negative SRS; CPKP was more frequently identified in CS than in SRS in MD. Twelve strains harboured more than one carbapenemase gene. Many other species harbouring a carbapenemase gene were collected. CONCLUSIONS MDs need more inclusive surveillance criteria. The late detection of positive SRS underlined the risk of colonization during hospitalization.
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Affiliation(s)
- Andrea Bartolini
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy
| | - Monica Basso
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy
| | - Elisa Franchin
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy
| | - Nicola Menegotto
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy
| | - Anna Ferrari
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy
| | - Ettore De Canale
- Microbiology and Virology Unit, Padova Hospital, Via Giustiniani, 2, 35121 Padova, Italy
| | - Samantha Andreis
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy
| | - Renzo Scaggiante
- Infectious Diseases Unit, Padova Hospital, Via Giustiniani, 2, 35128 Padova, Italy
| | - Stefania Stefani
- Department of Bio-Medical Sciences, University of Catania, Via Androne 81, 95124 Catania, Italy
| | - Giorgio Palù
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy
| | - Saverio Giuseppe Parisi
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100 Padova, Italy.
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22
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Previous bloodstream infections due to other pathogens as predictors of carbapenem-resistant Klebsiella pneumoniae bacteraemia in colonized patients: results from a retrospective multicentre study. Eur J Clin Microbiol Infect Dis 2016; 36:663-669. [DOI: 10.1007/s10096-016-2843-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
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