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Dangor Z, Benson N, Berkley JA, Bielicki J, Bijsma MW, Broad J, Buurman ET, Cross A, Duffy EM, Holt KE, Iroh Tam PY, Jit M, Karampatsas K, Katwere M, Kwatra G, Laxminarayan R, Le Doare K, Mboizi R, Micoli F, Moore CE, Nakabembe E, Naylor NR, O'Brien S, Olwagen C, Reddy D, Rodrigues C, Rosen DA, Sadarangani M, Srikantiah P, Tennant SM, Hasso-Agopsowicz M, Madhi SA. Vaccine value profile for Klebsiella pneumoniae. Vaccine 2024; 42:S125-S141. [PMID: 38503661 DOI: 10.1016/j.vaccine.2024.02.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/07/2024] [Accepted: 02/24/2024] [Indexed: 03/21/2024]
Abstract
Klebsiella pneumoniae causes community- and healthcare-associated infections in children and adults. Globally in 2019, an estimated 1.27 million (95% Uncertainty Interval [UI]: 0.91-1.71) and 4.95 million (95% UI: 3.62-6.57) deaths were attributed to and associated with bacterial antimicrobial resistance (AMR), respectively. K. pneumoniae was the second leading pathogen in deaths attributed to AMR resistant bacteria. Furthermore, the rise of antimicrobial resistance in both community- and hospital-acquired infections is a concern for neonates and infants who are at high risk for invasive bacterial disease. There is a limited antibiotic pipeline for new antibiotics to treat multidrug resistant infections, and vaccines targeted against K. pneumoniae are considered to be of priority by the World Health Organization. Vaccination of pregnant women against K. pneumoniae could reduce the risk of invasive K.pneumoniae disease in their young offspring. In addition, vulnerable children, adolescents and adult populations at risk of K. pneumoniae disease with underlying diseases such as immunosuppression from underlying hematologic malignancy, chemotherapy, patients undergoing abdominal and/or urinary surgical procedures, or prolonged intensive care management are also potential target groups for a K. pneumoniae vaccine. A 'Vaccine Value Profile' (VVP) for K.pneumoniae, which contemplates vaccination of pregnant women to protect their babies from birth through to at least three months of age and other high-risk populations, provides a high-level, holistic assessment of the available information to inform the potential public health, economic and societal value of a pipeline of K. pneumoniae vaccines and other preventatives and therapeutics. This VVP was developed by a working group of subject matter experts from academia, non-profit organizations, public-private partnerships, and multi-lateral organizations, and in collaboration with stakeholders from the WHO. All contributors have extensive expertise on various elements of the K.pneumoniae VVP and collectively aimed to identify current research and knowledge gaps. The VVP was developed using only existing and publicly available information.
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Affiliation(s)
- Ziyaad Dangor
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
| | - Nicole Benson
- Global Health Division, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - James A Berkley
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine & Global Health, University of Oxford, UK
| | - Julia Bielicki
- Centre for Neonatal and Paediatric Infection, St George's, University of London, UK; Paediatric Research Centre (PRC), University of Basel Children's Hospital, Basel, Switzerland
| | - Merijn W Bijsma
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Pediatrics, Amsterdam Neuroscience, Meibergdreef, Amsterdam, the Netherlands
| | | | - Ed T Buurman
- CARB-X, Boston University, Boston, MA 02215, USA
| | - Alan Cross
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Erin M Duffy
- CARB-X, Boston University, Boston, MA 02215, USA
| | - Kathryn E Holt
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria 3004, Australia
| | - Pui-Ying Iroh Tam
- Paediatrics and Child Health Research Group, Malawi-Liverpool Wellcome Programme, Blantyre, Malawi
| | - Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | | | - Michael Katwere
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Gaurav Kwatra
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA; Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | | | - Kirsty Le Doare
- Centre for Neonatal and Paediatric Infection, St George's, University of London, UK; UK Health Security Agency, Porton Down, UK; World Health Organization, Geneva, Switzerland
| | - Robert Mboizi
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | | | - Catrin E Moore
- Centre for Neonatal and Paediatric Infection, St George's, University of London, UK
| | - Eve Nakabembe
- Department of Obstetrics and Gynaecology, School of Medicine, Makerere University College of Health Sciences, Upper Mulago Hill Road, P.O. Box 7072 Kampala, Uganda
| | - Nichola R Naylor
- UK Health Security Agency, Porton Down, UK; Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Seamus O'Brien
- Global Antibiotic Research & Development Partnership (GARDP), Geneva, Switzerland
| | - Courtney Olwagen
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Denasha Reddy
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Charlene Rodrigues
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; Dept of Paediatrics, Imperial College Healthcare NHS Trust, London, UK; Pathogen Genomics Programme, UK Health Security Agency, London, UK
| | - David A Rosen
- Department of Pediatrics and Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada; Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Padmini Srikantiah
- Global Health Division, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Sharon M Tennant
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mateusz Hasso-Agopsowicz
- Department of Immunization, Vaccines & Biologicals, World Health Organization, Geneva, Switzerland
| | - Shabir A Madhi
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
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Kuloglu TO, Unuvar GK, Cevahir F, Kilic AU, Alp E. Risk factors and mortality rates of carbapenem-resistant Gram-negative bacterial infections in intensive care units. JOURNAL OF INTENSIVE MEDICINE 2024; 4:347-354. [PMID: 39035617 PMCID: PMC11258511 DOI: 10.1016/j.jointm.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 07/23/2024]
Abstract
Background The prevalence of hospital-acquired infections caused by carbapenem-resistant gram-negative bacteria (CRGNB) is increasing worldwide. Several risk factors have been associated with such infections. The present study aimed to identify risk factors and determine the mortality rates associated with CRGNB infections in intensive care units. Methods This retrospective case-control study was conducted at Erciyes University Hospital (Kayseri, Turkey) between January 2017 and December 2021. Demographic and laboratory data were obtained from the Infection Control Committee data and record system. Patients who had CRGNB infection 48-72 h after hospitalization were assigned to the case group, while those who were not infected with CRGNB during hospitalization formed the control group. Risk factors, comorbidity, demographic data, and mortality rates were compared between the two groups. Results Approximately 1449 patients (8.97%) were monitored during the active follow-up period; of those, 1171 patients were included in this analysis. CRGNB infection developed in 14 patients (70.00%) who had CRGNB colonization at admission; in 162 (78.26%) were colonized during hospitalization, whereas 515 (54.56%) were not colonized. There was no significant difference in age, sex (male/female) or comorbidities. The total length of hospital stay was statistically significantly longer (P=0.001) in the case group (median: 24 [interquartile range: 3-378] days) than the control group (median: 16 [interquartile range: 3-135] days). The rates of colonization at admission (25.5%; vs. 10.6%, P=0.001) and mortality (64.4% vs. 45.8%, P=0.001) were also significantly higher in the cases than in the control group, respectively. In the univariate analysis, prolonged hospitalization, the time from intensive care unit admission to the development of infection, presence of CRGNB colonization at admission, transfer from other hospitals, previous antibiotic use, enteral nutrition, transfusion, hemodialysis, mechanical ventilation, tracheostomy, reintubation, central venous catheter, arterial catheterization, chest tube, total parenteral nutrition, nasogastric tube use, and bronchoscopy procedures were significantly associated with CRGNB infections (P <0.05). Multivariate analysis identified the total length of stay in the hospital (odds ratio [OR]=1.02; 95% confidence interval [CI]: 1.01 to 1.03; P=0.001), colonization (OR=2.19; 95% CI: 1.53 to 3.13; P=0.001), previous antibiotic use (OR=2.36; 95% CI: 1.53 to 3.62; P=0.001), intubation (OR=1.59; 95% CI: 1.14 to 2.20; P=0.006), tracheostomy (OR=1.42; 95% CI: 1.01 to 1.99; P=0.047), and central venous catheter use (OR=1.62; 95% CI: 1.20 to 2.19; P=0.002) as the most important risk factors for CRGNB infection. Conclusions Colonization, previous use of antibiotics, and invasive interventions were recognized as the most important risk factors for infections. Future research should focus on measures for the control of these parameters.
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Affiliation(s)
- Tulay Orhan Kuloglu
- Infection Control Committee, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Gamze Kalin Unuvar
- Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Fatma Cevahir
- Programme of First and Emergency Aid, Sakarya University, Sakarya, Turkey
| | - Aysegul Ulu Kilic
- Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Emine Alp
- Department of Infectious Diseases, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
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Fang P, Gao K, Yang J, Li T, Sun Q, Shan Z, Wang Y. Clinical characteristics and risk factors for neonatal bloodstream infection due to carbapenem-resistant Enterobacteriaceae: A single-centre Chinese retrospective study. J Glob Antimicrob Resist 2024; 37:28-36. [PMID: 38412919 DOI: 10.1016/j.jgar.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/09/2024] [Accepted: 02/10/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVES To analyse the clinical characteristics and risk factors for bloodstream infections (BSIs) caused by carbapenem-resistant Enterobacteriaceae (CRE) in neonates. METHODS This single-centre, retrospective study included all patients with BSIs admitted to a neonatal intensive care unit between 1 January 2015 and 30 April 2022. The clinical and microbiological data of patients were collected; predictors of 30-day mortality in patients with CRE BSIs were also identified in this study. RESULTS Among the 224 neonates with Enterobacteriaceae BSIs, 39.29% (88/224) of the patients developed CRE BSIs. The 30-day mortality rate reached up to 21.59% (19/88). The Quick Sequential Organ Failure Assessment score > 2 (odds ratio [OR] and 95% credibility interval [CI]: 3.852 [1.111-13.356], P < 0.05), prior to more than two kinds of antibiotics use (OR and 95% CI: 9.433 [1.562-56.973], P < 0.05), pneumonia (OR and 95% CI: 3.847 [1.133-13.061], P < 0.05), and caesarean section (OR and 95% CI: 2.678 [1.225-5.857], P < 0.05) were independent risk factors associated with CRE BSIs. Moreover, the risk factors for mortality in neonates with CRE BSIs were significantly associated with neonatal Sequential Organ Failure Assessment score > 6 (OR and 95% CI: 16.335 [1.446-184.517], P < 0.05). CONCLUSION Prior to more than two kinds of antibiotics use, Quick Sequential Organ Failure Assessment score > 2, pneumonia and caesarean section were independent risk factors for CRE BSIs. The Neonatal Sequential Organ Failure Assessment score > 6 was a risk factor for mortality associated with CRE BSIs.
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Affiliation(s)
- Panpan Fang
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Kaijie Gao
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Junmei Yang
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China.
| | - Tiewei Li
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Qianqian Sun
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Zhiming Shan
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Yingyuan Wang
- Department of Neonatal Intensive Care Unit, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
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Chu X, Ning L, Fang Y, Jia H, Wang M. Risk Factors and Predictive Nomogram for Carbapenem-Resistant Klebsiella pneumoniae in Children in a Grade 3 First-Class General Hospital in Central China. Infect Drug Resist 2024; 17:41-49. [PMID: 38197067 PMCID: PMC10775694 DOI: 10.2147/idr.s437742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/25/2023] [Indexed: 01/11/2024] Open
Abstract
Background This study determined risk factors for Carbapenem-resistant Klebsiella pneumoniae (CRKP)in children admitted to a grade 3 first-class general hospital and developed an individualized line graph predictive model. Methods The clinical data of 185 children infected with Klebsiella pneumoniae from January 2015 to December 2019 were analyzed retrospectively. Patients were grouped according to carbapenem resistance: CRKP group (50 cases) and CSKP (carbapenem-sensitive Klebsiella pneumoniae) group (135 cases). Risk factors for CRKP in children were screened by logistic regression analysis. The predictive model was established using R software and validated using the Bootstrap method. Results Age (odds ratio [OR]=0.104, 95% confidence interval [CI]: 0.026-0.408), intensive care unit admission (OR =2.829, 95% CI: 1.138-7.030), mechanical ventilation (OR =7.510, 95% CI: 3.140-17.961), surgery history (OR =5.005, 95% CI: 1.507-16.618) and glucocorticoid (OR =0.235, 95% CI: 0.099-0.557) were independent risk factors for CRKP in children (P < 0.05), The total risk score of each factor was 362.5, and the risk rate was 0.1-0.9. In receiver-operating characteristic curve analysis, the area under the curve of CRKP predicted by the total risk score was 0.872 (95% CI=0.844-0.901; P < 0.001). The correction curve indicated that the consistency between the observed value and the predicted value was good. Discussion and Conclusion This study successfully established a model based on the risk factors, with high accuracy and good predictive value for CRKP in children. Hospitals should take necessary preventive measures against the risk factors for drug-resistant bacteria, such as optimizing the configuration of ICU space, timely isolation of infected children, and adequate disinfection of ICU equipment. Which may reduce CRKP infection rate.
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Affiliation(s)
- Xinmin Chu
- Department of Clinical Laboratory, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China
| | - Lijuan Ning
- Department of Pharmacy, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China
- Anhui Provincial Key Laboratory of Precision Pharmaceutical Preparations and Clinical Pharmacy, Hefei, Anhui, 230001, People’s Republic of China
| | - Yuting Fang
- Department of Pharmacy, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China
- Anhui Provincial Key Laboratory of Precision Pharmaceutical Preparations and Clinical Pharmacy, Hefei, Anhui, 230001, People’s Republic of China
| | - Hengmin Jia
- Department of Infection Office, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China
| | - Meng Wang
- Department of Pharmacy, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China
- Anhui Provincial Key Laboratory of Precision Pharmaceutical Preparations and Clinical Pharmacy, Hefei, Anhui, 230001, People’s Republic of China
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Wang H, Tian F, Wang X, Zhao M, Gao R, Cui X. Analysis of Risk Factors for Carbapenem Resistant Klebsiella pneumoniae Infection and Construction of Nomogram Model: A Large Case-Control and Cohort Study from Shanxi, China. Infect Drug Resist 2023; 16:7351-7363. [PMID: 38050629 PMCID: PMC10693770 DOI: 10.2147/idr.s442909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/22/2023] [Indexed: 12/06/2023] Open
Abstract
Background Healthcare-associated infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) are now a global public health problem, increasing the burden of disease and public healthcare expenditures in various countries. The aim of this study was to analyse the risk factors for CRKP infections and to develop nomogram models to help clinicians predict CRKP infections at an early stage to facilitate diagnosis and treatment. Methods The clinical data of patients with Klebsiella pneumoniae (KP) infections in our hospital from January 2018 to January 2023 were collected. 174 patients with CRKP infections and 219 patients with CSKP infections were selected for case-control study. 27 predictors related to CRKP infections were determined. The least absolute shrinkage and selection operator (Lasso) regression was used to screen the characteristic variables, Multivariate logistic regression analysis was performed on the selected variables and a nomogram model was established. The discrimination and calibration of the nomogram model were evaluated by receiver operator curves (ROC) and calibration curves. Results Six predictive factors of ICU stay, fever time, central venous catheterization time, catheter indwelling time, carbapenem use and tetracycline use screened by lasso regression were included in the logistic regression model, and the nomogram was drawn to visualize the results. The area under ROC curve of training set and validation set was 0.894 (95% CI: 0.857, 0.931) and 0.872 (95% CI: 0.805, 0.939); The results of decision curve analysis also show that the model has good prediction accuracy. Conclusion This study established a nomogram to predict CRKP infection based on lasso-logistic regression model, which has certain guiding significance for early diagnosis of CRKP infections.
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Affiliation(s)
- Hongwei Wang
- Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Fangying Tian
- Infection Management Department of the Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Xueyu Wang
- Department of Infectious Diseases, First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Ming Zhao
- Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Ruiqin Gao
- Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Xinyu Cui
- Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
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Çölkesen F, Tarakçı A, Eroğlu E, Kacar F, Özdemir Armağan Ş, Can S, Erol B, Aksay O, Çölkesen F. Carbapenem-Resistant Klebsiella pneumoniae Infection and Its Risk Factors in Older Adult Patients. Clin Interv Aging 2023; 18:1037-1045. [PMID: 37435410 PMCID: PMC10332362 DOI: 10.2147/cia.s406214] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/08/2023] [Indexed: 07/13/2023] Open
Abstract
Introduction Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection has recently gained worldwide interest due to limited treatment options and high morbidity and mortality rates. The aim of this study was to determine the risk factors of carbapenem-resistant K. pneumoniae (CRKP) infection in older adult patients. Material and Methods This retrospective, single-center study included 132 patients with healthcare-associated CRKP infection (case group) and 150 patients with healthcare-associated carbapenem-susceptible K. pneumoniae (CSKP) infection (control group), aged > 65 years. Results In the CRKP and CSKP groups, 79 (59.8%) and 80 (53.3%) patients were males, and the mean ages were 77.8 ± 7.8 and 76.6 ± 7.7 years, respectively. Diabetes mellitus (DM), malignancy, cardiovascular diseases (CVDs), surgical intervention, invasive mechanical ventilation, central venous catheter insertion, parenteral nutrition, hospitalization in the previous 6 months, antibiotic use in the previous 3 months, and exposure to cephalosporins, fluoroquinolones, and carbapenems were significantly more common in the CRKP than the CSKP group (all p < 0.05). The multivariate logistic regression analysis identified malignancy, CVDs, DM, invasive mechanical ventilation, hospitalization in the previous 6 months, ICU admission, and exposure to cephalosporins, quinolones, and carbapenems as independent risk factors for CRKP infection in older adult patients. Conclusion DM, malignancy, CVDs, ICU admission, invasive mechanical ventilation, and exposure to ceftriaxone, fluoroquinolones, and carbapenems were independent risk factors for CRKP infection in older adult patients. The identification of risk factors for CRKP infection can help to prevent and treat CRKP infection.
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Affiliation(s)
- Fatma Çölkesen
- Department of Infectious Diseases and Clinical Microbiology, Konya Numune Hospital, Konya, Turkey
| | - Arzu Tarakçı
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Konya City Hospital, Konya, Turkey
| | - Esma Eroğlu
- Department of Infectious Diseases and Clinical Microbiology, Meram State Hospital, Konya, Turkey
| | - Fatma Kacar
- Department of Infectious Diseases and Clinical Microbiology, Medova Hospital, Konya, Turkey
| | - Şule Özdemir Armağan
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Konya City Hospital, Konya, Turkey
| | - Selver Can
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Beyhekim Training and Research Hospital, Konya, Turkey
| | - Bağdat Erol
- Infection Control Committee, University of Health Sciences, Konya City Hospital, Konya, Turkey
| | - Oyagül Aksay
- Infection Control Committee, University of Health Sciences, Konya City Hospital, Konya, Turkey
| | - Fatih Çölkesen
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
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Chen J, Ma H, Huang X, Cui Y, Peng W, Zhu F, Ma S, Rao M, Zhang P, Yang H, Su L, Niu R, Pan P. Risk factors and mortality of carbapenem-resistant Klebsiella pneumoniae bloodstream infection in a tertiary-care hospital in China: an eight-year retrospective study. Antimicrob Resist Infect Control 2022; 11:161. [PMID: 36536423 PMCID: PMC9761986 DOI: 10.1186/s13756-022-01204-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The prevalence of carbapenem-resistant Klebsiella pneumoniae bloodstream infection (CRKP-BSI) is increasing worldwide. CRKP-BSI is associated with high rates of morbidity and mortality due to limited antibiotic choices. Here, we aim to identify the prevalence and risk factors for infection and mortality of CRKP BSI. METHODS This was a retrospective study of the past data from January 1st, 2012 to December 31st, 2019 of adult patients with KP-BSI in Xiangya Hospital, China. RESULTS Among the 706 incidences included in this study, 27.4% of them (212/753) being CR-KP strains. The occurrence of CRKP-BSI was increased from 20.69 to 37.40% from 2012 to 2019. Hematologic malignancies and ICU acquired infection were identified to be substantial risk factors of carbapenem resistance. The overall 28-day mortality rates of CRKP-BSI patients was significantly higher than that of CSKP-BSI (P < 0.001). Logistic regression analysis identified severe sepsis or septic shock incidents, inadequate empirical antimicrobial therapy and corticosteroids use preceding infection onset as the independent predictors of 28-day mortality of CRKP-BSI patients. However, high dose carbapenem combination therapy was identified as anticipated factors of low 28-day mortality. CONCLUSION The occurrence of CRKP-BSI was significantly increased during the study period. Hematologic malignancies and ICU acquired infection were associated with the development of CRKP BSI. Severe sepsis or septic shock incidents, inadequate empirical antimicrobial therapy and corticosteroids use preceding infection onset caused significant increase of mortality rates in CRKP-BSI patients. High dose carbapenem combination therapy was associated with better outcome.
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Affiliation(s)
- Jie Chen
- grid.452223.00000 0004 1757 7615Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, No. 28 Xiangya Road, Kai-Fu District, Changsha, 410008 Hunan People’s Republic of China ,grid.452223.00000 0004 1757 7615Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, 410008 Hunan People’s Republic of China ,Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, 410008 Hunan People’s Republic of China ,Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, 410008 Hunan People’s Republic of China ,grid.452223.00000 0004 1757 7615National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, 410008 Hunan People’s Republic of China
| | - Hua Ma
- Department of Infectious Disease, People’s Hospital of Liuyang City, Liuyang, 410300 Hunan People’s Republic of China
| | - Xiaoming Huang
- Department of Respiratory Medicine, Traditional Chinese Medicine Hospital of Leiyang City, Hengyang, Hunan People’s Republic of China
| | - Yanhui Cui
- grid.452223.00000 0004 1757 7615Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, No. 28 Xiangya Road, Kai-Fu District, Changsha, 410008 Hunan People’s Republic of China ,grid.452223.00000 0004 1757 7615Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, 410008 Hunan People’s Republic of China ,Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, 410008 Hunan People’s Republic of China ,Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, 410008 Hunan People’s Republic of China ,grid.452223.00000 0004 1757 7615National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, 410008 Hunan People’s Republic of China
| | - Wenzhong Peng
- grid.452223.00000 0004 1757 7615Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, No. 28 Xiangya Road, Kai-Fu District, Changsha, 410008 Hunan People’s Republic of China ,grid.452223.00000 0004 1757 7615Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, 410008 Hunan People’s Republic of China ,Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, 410008 Hunan People’s Republic of China ,Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, 410008 Hunan People’s Republic of China ,grid.452223.00000 0004 1757 7615National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, 410008 Hunan People’s Republic of China
| | - Fei Zhu
- grid.452223.00000 0004 1757 7615Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, No. 28 Xiangya Road, Kai-Fu District, Changsha, 410008 Hunan People’s Republic of China ,grid.452223.00000 0004 1757 7615Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, 410008 Hunan People’s Republic of China ,Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, 410008 Hunan People’s Republic of China ,Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, 410008 Hunan People’s Republic of China ,grid.452223.00000 0004 1757 7615National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, 410008 Hunan People’s Republic of China
| | - Shiyang Ma
- grid.452223.00000 0004 1757 7615Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, No. 28 Xiangya Road, Kai-Fu District, Changsha, 410008 Hunan People’s Republic of China ,grid.452223.00000 0004 1757 7615Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, 410008 Hunan People’s Republic of China ,Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, 410008 Hunan People’s Republic of China ,Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, 410008 Hunan People’s Republic of China ,grid.452223.00000 0004 1757 7615National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, 410008 Hunan People’s Republic of China
| | - Minjun Rao
- grid.452223.00000 0004 1757 7615Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, No. 28 Xiangya Road, Kai-Fu District, Changsha, 410008 Hunan People’s Republic of China ,grid.452223.00000 0004 1757 7615Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, 410008 Hunan People’s Republic of China ,Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, 410008 Hunan People’s Republic of China ,Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, 410008 Hunan People’s Republic of China ,grid.452223.00000 0004 1757 7615National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, 410008 Hunan People’s Republic of China
| | - Peipei Zhang
- grid.452223.00000 0004 1757 7615Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, No. 28 Xiangya Road, Kai-Fu District, Changsha, 410008 Hunan People’s Republic of China ,grid.452223.00000 0004 1757 7615Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, 410008 Hunan People’s Republic of China ,Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, 410008 Hunan People’s Republic of China ,Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, 410008 Hunan People’s Republic of China ,grid.452223.00000 0004 1757 7615National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, 410008 Hunan People’s Republic of China
| | - Hang Yang
- grid.452223.00000 0004 1757 7615Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, No. 28 Xiangya Road, Kai-Fu District, Changsha, 410008 Hunan People’s Republic of China ,grid.452223.00000 0004 1757 7615Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, 410008 Hunan People’s Republic of China ,Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, 410008 Hunan People’s Republic of China ,Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, 410008 Hunan People’s Republic of China ,grid.452223.00000 0004 1757 7615National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, 410008 Hunan People’s Republic of China
| | - Longxiang Su
- grid.413106.10000 0000 9889 6335Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 1st Shuaifuyuan, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Ruichao Niu
- grid.452223.00000 0004 1757 7615Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, No. 28 Xiangya Road, Kai-Fu District, Changsha, 410008 Hunan People’s Republic of China ,grid.452223.00000 0004 1757 7615Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, 410008 Hunan People’s Republic of China ,Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, 410008 Hunan People’s Republic of China ,Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, 410008 Hunan People’s Republic of China ,grid.452223.00000 0004 1757 7615National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, 410008 Hunan People’s Republic of China ,grid.512482.8Department of Respiratory Medicine, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region People’s Republic of China
| | - Pinhua Pan
- grid.452223.00000 0004 1757 7615Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, No. 28 Xiangya Road, Kai-Fu District, Changsha, 410008 Hunan People’s Republic of China ,grid.452223.00000 0004 1757 7615Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, 410008 Hunan People’s Republic of China ,Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, 410008 Hunan People’s Republic of China ,Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, 410008 Hunan People’s Republic of China ,grid.452223.00000 0004 1757 7615National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, 410008 Hunan People’s Republic of China
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8
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Hou M, Chen N, Dong L, Fang Y, Pan R, Wang W, Wang L, Ning J, Dong H. Molecular Epidemiology, Clinical Characteristics and Risk Factors for Bloodstream Infection of Multidrug-Resistant Klebsiella pneumoniae Infections in Pediatric Patients from Tianjin, China. Infect Drug Resist 2022; 15:7015-7023. [PMID: 36483148 PMCID: PMC9725917 DOI: 10.2147/idr.s389279] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/14/2022] [Indexed: 11/01/2023] Open
Abstract
PURPOSE The data on pediatrics with Multidrug-Resistant (MDR) Klebsiella pneumoniae infections are scarce. This study aims to investigate the molecular epidemiology of MDR Klebsiella pneumoniae, detect the mechanism of drug resistance, and determine the clinical risk factors for carbapenem-resistant Klebsiella pneumonia (CRKP) bloodstream infections (BSIs) in a children's hospital. METHODS A total of 62 strains were collected from Tianjin Children's Hospital. Carba NP and polymerase chain reactions (PCR) were performed to detect MDR mechanisms. Multilocus sequence typing (MLST) was used for analyzing strain homology. Clinical data were collected and logistic regression was used for BSI risk factors. RESULTS ST11 was the principal ST among the CRKP isolates clinically, accounting for 56.45% (35/62); there were also 57.14% (20/35) ST11 CRKP strains co-carrying bla NDM-5 and bla KPC-2, which were resistant to most of the tested antibiotics, being susceptible only to cotrimoxazole and tigecycline. The clinical data showed that 72.73% (40/55) of children with CRKP infection had serious underlying diseases; 20.00% (11/55) patients developed BSIs with the potential to cause multiple organ failure, shock and death. The logistic regression showed that the risk of BSIs caused by CRKP strain infections in children with hematological malignancies after chemotherapy was 7 times that of other children (95%Cl: 1.298-45.415, P=0.025). CONCLUSION ST11 was the prevalent clone in our hospital. The emergence of ST11 CRKP co-carrying bla NDM-5 and bla KPC-2 should be a cause for alarm as they were resistant to most of the tested antibiotics. CRKP strain infections are mainly occurring in young immunocompromised patients and the chemotherapy for hematological malignancies is an independent risk factor for BSIs.
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Affiliation(s)
- Mengzhu Hou
- Tianjin Pediatric Research Institute, Tianjin Children’s Hospital (Children’s Hospital of Tianjin University), Tianjin, People’s Republic of China
| | - Nan Chen
- Department of Clinical Lab, Tianjin Children’s Hospital (Children’s Hospital of Tianjin University), Tianjin, People’s Republic of China
| | - Lili Dong
- Department of Respiratory, Tianjin Children’s Hospital (Children’s Hospital of Tianjin University), Tianjin, People’s Republic of China
| | - Yulian Fang
- Tianjin Pediatric Research Institute, Tianjin Children’s Hospital (Children’s Hospital of Tianjin University), Tianjin, People’s Republic of China
| | - Rui Pan
- Department of Clinical Lab, Tianjin Children’s Hospital (Children’s Hospital of Tianjin University), Tianjin, People’s Republic of China
| | - Wei Wang
- Tianjin Pediatric Research Institute, Tianjin Children’s Hospital (Children’s Hospital of Tianjin University), Tianjin, People’s Republic of China
| | - Lu Wang
- Tianjin Pediatric Research Institute, Tianjin Children’s Hospital (Children’s Hospital of Tianjin University), Tianjin, People’s Republic of China
| | - Jing Ning
- Department of Respiratory, Tianjin Children’s Hospital (Children’s Hospital of Tianjin University), Tianjin, People’s Republic of China
| | - Hanquan Dong
- Department of Respiratory, Tianjin Children’s Hospital (Children’s Hospital of Tianjin University), Tianjin, People’s Republic of China
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9
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Zhao J, Zheng B, Xu H, Li J, Sun T, Jiang X, Liu W. Emergence of a NDM-1-producing ST25 Klebsiella pneumoniae strain causing neonatal sepsis in China. Front Microbiol 2022; 13:980191. [PMID: 36338063 PMCID: PMC9630351 DOI: 10.3389/fmicb.2022.980191] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022] Open
Abstract
Carbapenem-resistant Klebsiella pneumoniae (CRKP) seriously threaten the efficacy of modern medicine with a high associated mortality rate and unprecedented transmission rate. In this study, we isolated a clinical K. pneumoniae strain DY1928 harboring blaNDM-1 from a neonate with blood infection. Antimicrobial susceptibility testing indicated that DY1928 was resistant to various antimicrobial agents, including meropenem, imipenem, ceftriaxone, cefotaxime, ceftazidime, cefepime, piperacillin-tazobactam, and amoxicillin-clavulanate. S1 nuclease-pulsed field gel electrophoresis (S1-PFGE), southern blot and conjugation experiment revealed that the blaNDM-1 gene was located on a conjugative plasmid of IncA/C2 type with a 147.9 kb length. Whole-genome sequencing showed that there was a conservative structure sequence (blaNDM-1-ble-trpF-dsbD) located downstream of the blaNDM-1 gene. Multilocus sequence typing (MLST) classified DY1928 as ST25, which was a hypervirulent K. pneumoniae type. Phylogenetic analysis of genomic data from all ST25 K. pneumoniae strains available in the NCBI database suggested that all blaNDM-1 positive strains were isolated in China and had clinical origins. A mouse bloodstream infection model was constructed to test the virulence of DY1928, and 11 K. pneumoniae strains homologous to DY1928 were isolated from the feces of infected mice. Moreover, we found that DY1928 had a tendency to flow from the blood into the intestine in mice and caused multiple organ damage. To our knowledge, this is the first study to report an infection caused by blaNDM-1-positive ST25 K. pneumoniae in the neonatal unit. Our findings indicated that stricter surveillance and more effective actions were needed to reduce the risk of disseminating such K. pneumoniae strains in clinical settings, especially in neonatal wards.
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Affiliation(s)
- Junhui Zhao
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Beiwen Zheng
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hao Xu
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Junfeng Li
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Tengfei Sun
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiawei Jiang
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
- Xiawei Jiang,
| | - Wenhong Liu
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
- *Correspondence: Wenhong Liu,
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10
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Wang L, Yuan XD, Pang T, Duan SH. The Risk Factors of Carbapenem-Resistant Klebsiella pneumoniae Infection: A Single-Center Chinese Retrospective Study. Infect Drug Resist 2022; 15:1477-1485. [PMID: 35411153 PMCID: PMC8994608 DOI: 10.2147/idr.s352070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/11/2022] [Indexed: 11/23/2022] Open
Abstract
Objective The present study aims to explore potential infection and death risk factors in patients infected with carbapenem-resistant Klebsiella pneumoniae (CRKP). Methods A retrospective case-control study was performed at Beijing Shijitan Hospital, China. The clinical and microbiological data of patients infected with K. pneumoniae (K.pn) were collected; the clinical characteristics of patients infected with carbapenem-susceptible K.pn and CRKP were analyzed using logistic regression analysis. Results CRKP infection was significantly associated with prior carbapenem use (odds ratio [OR] and 95% credibility interval [CI]: 5.161 [1.840-32.233], P < 0.001), the use of more than three types of antibiotics for seven or more days (OR and 95% CI: 9.681 [2.662-18.122], P < 0.001), tracheotomy (OR and 95% CI: 5.015 [2.343-11.724], P < 0.001), and intensive care unit (ICU) stay (OR and 95% CI: 6.322 [2.02-12.231], P < 0.001). The risk of death in patients with CRKP infection was significantly associated with older age (OR and 95% CI of 70-80 years: 8.894 [1.972-67.346], P < 0.001; ≥80 years: 15.234 [2.072-93.452], P < 0.001), renal dysfunction (OR and 95% CI: 1.672 [1.104-7.451], P = 0.016), tracheotomy (OR and 95% CI: 2.051 [1.217-11.235], P = 0.002), and ICU stay (OR and 95% CI: 3.043 [2.174-18.453], P < 0.001). Conclusion Prior to carbapenem use, older age, renal dysfunction, tracheotomy, and ICU stay were independent risk factors for death in patients infected with CRKP.
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Affiliation(s)
- Lei Wang
- Department of Infectious Diseases, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People’s Republic of China
| | - Xiao-Dong Yuan
- Department of Infectious Diseases, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People’s Republic of China
| | - Ting Pang
- Department of Infectious Diseases, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People’s Republic of China
| | - Shu-Hong Duan
- Department of Infectious Diseases, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People’s Republic of China
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11
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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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12
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Zhou R, Fang X, Zhang J, Zheng X, Shangguan S, Chen S, Shen Y, Liu Z, Li J, Zhang R, Shen J, Walsh TR, Wang Y. Impact of carbapenem resistance on mortality in patients infected with Enterobacteriaceae: a systematic review and meta-analysis. BMJ Open 2021; 11:e054971. [PMID: 34907071 PMCID: PMC8672018 DOI: 10.1136/bmjopen-2021-054971] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To provide a comprehensive assessment of the impact of carbapenem resistance on mortality among patients infected with Enterobacteriaceae and to explore the source of heterogeneity across studies. DESIGN This systematic review was conducted following the guidelines of Cochrane Guidance and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. DATA SOURCES We conducted a systematic literature search of the PubMed, Embase, Web of Science and Cochrane Library databases to identify relevant studies published between 1 January 1994 and 30 August 2020. ELIGIBILITY CRITERIA We included primary observational studies published in English that reported the mortality outcomes for hospitalised patients with confirmed infections due to carbapenem-resistant Enterobacteriaceae (CRE) and carbapenem-susceptible Enterobacteriaceae (CSE). Studies with no comparison group or with a comparison group of patients infected with unconfirmed CSE were excluded. DATA EXTRACTION AND SYNTHESIS Data extraction and assessment of risk bias were conducted independently by two reviewers. The pooled relative risk and risk difference were calculated as effect measures with 95% CIs using a random effects model. The heterogeneity across studies was assessed by Q-statistic and I2 measures. RESULTS Of 10 304 studies initially identified, 50 studies were included in the meta-analyses. The results of the meta-analyses showed that carbapenem resistance has a significant positive effect on the probability of death for patients infected with Enterobacteriaceae for any type of mortality outcome. The results of the stratified analysis and meta-regression suggested that the effect of carbapenem resistance on the risk of death varied by infection type, sample size and year of publication. CONCLUSIONS Our results suggested that patients with CRE infection still face a greater risk of death than patients with CSE infection do, and an urgent need to develop new antibiotics and appropriate treatments to reduce the risk of death. PROSPERO REGISTRATION NUMBER CRD42020176808.
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Affiliation(s)
- Ruyin Zhou
- Department of Economics and Trade, College of Economics and Management, China Agricultural University, Beijing, China
| | - Xiangming Fang
- Department of Economics and Trade, College of Economics and Management, China Agricultural University, Beijing, China
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Jinjin Zhang
- Department of Economics and Trade, College of Economics and Management, China Agricultural University, Beijing, China
| | - Xiaodong Zheng
- Department of Economics, School of Economics, Zhejiang Gongshang University, Hangzhou, China
| | - Shuangyue Shangguan
- Department of Economics and Trade, College of Economics and Management, China Agricultural University, Beijing, China
| | - Shibo Chen
- Department of Basic Veterinary Medicine, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Yingbo Shen
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Zhihai Liu
- Agricultural Bio-pharmaceutical Laboratory, College of Chemistry and Pharmaceutical Sciences, Qingdao Agricultural University, Qingdao, China
| | - Juan Li
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, Beijing, China
| | - Rong Zhang
- Clinical Laboratory Medicine, The Second Affiliated Hospital of Zhejiang University, Zhejiang University, Hangzhou, China
| | - Jianzhong Shen
- Beijing Key Laboratory of Detection Technology for Animal-Derived Food Safety, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | | | - Yang Wang
- Beijing Key Laboratory of Detection Technology for Animal-Derived Food Safety, College of Veterinary Medicine, China Agricultural University, Beijing, China
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13
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Shao C, Wang W, Liu S, Zhang Z, Jiang M, Zhang F. Molecular Epidemiology and Drug Resistant Mechanism of Carbapenem-Resistant Klebsiella pneumoniae in Elderly Patients With Lower Respiratory Tract Infection. Front Public Health 2021; 9:669173. [PMID: 34095072 PMCID: PMC8172620 DOI: 10.3389/fpubh.2021.669173] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/26/2021] [Indexed: 12/15/2022] Open
Abstract
Infection by carbapenem-resistant Klebsiella pneumoniae (CRKp) hampers the treatment of elderly patients with lower respiratory tract infection (LRTI); however, relevant data with respect to the characteristics of CRKp in elderly patients with LRTIs are limited. In the present study, K. pneumoniae isolated from elderly patients with LRTIs was collected and identified by VITEK-MS. VITEK 2 compact was used for drug sensitivity test to screen CRKps, and broth dilution method was used for drug sensitivity of tigecycline and colistin. The resistance genes, virulence genes, and serotypes of CRKps were detected via polymerase chain reaction. The homology of CRKps was analyzed via PFGE and MLST. Moreover, plasmid conjugation experiment was carried out to determine the transferability of carbapenem resistance. PCR-based replicon typing (PBRT) and S1 nuclease-PFGE were conducted for plasmid profiling. From January 2019 to August 2019, 258 elderly patients with LRTIs caused by K. pneumoniae were observed; of these, 31 (12.02%) infections were caused by CRKp strains. Majority of the patients were admitted to the intensive care unit and neurosurgery wards. Intracranial hemorrhage and pneumonia were the most common underlying diseases. Furthermore, 29 patients infected by CRKp had been exposed to various antimicrobial drugs before the positive culture. All isolates exhibited high resistance to β-lactam antibiotics. The predominant carbapenem resistance gene was blaKPC−2, and CRKps carrying blaKPC−2 were all ST11 type. Two blaNDM−5 carrying isolates were assigned to ST307 and ST1562, respectively. Conjugative assays revealed that plasmids harboring blaNDM−5 gene were self-transmissible. Plasmid analysis suggested that two blaNDM−5 were located on a ~45 kb IncX3 type plasmid. The high incidence of CRKp in elderly patients with LRTIs indicates the urgent need for further surveillance and strict infection control measures.
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Affiliation(s)
- Chunhong Shao
- Clinical Laboratory of Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
| | - Wei Wang
- Intensive Care Department of Taian City Central Hospital, Shandong, China
| | - Shuang Liu
- Hematology Department of Taian City Central Hospital, Shandong, China
| | - Zhijun Zhang
- Clinical Laboratory of Taian City Central Hospital, Shandong, China
| | - Meijie Jiang
- Clinical Laboratory of Taian City Central Hospital, Shandong, China
| | - Fusen Zhang
- Intensive Care Department of Taian City Central Hospital, Shandong, China
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14
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Puzniak L, Dillon R, Palmer T, Collings H, Enstone A. Real-world use of ceftolozane/tazobactam: a systematic literature review. Antimicrob Resist Infect Control 2021; 10:68. [PMID: 33832545 PMCID: PMC8027296 DOI: 10.1186/s13756-021-00933-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/26/2021] [Indexed: 11/17/2022] Open
Abstract
Background Antibacterial-resistant gram-negative infections are a serious risk to global public health. Resistant Enterobacterales and Pseudomonas aeruginosa are highly prevalent, particularly in healthcare settings, and there are limited effective treatment options. Patients with infections caused by resistant pathogens have considerably worse outcomes, and incur significantly higher costs, relative to patients with susceptible infections. Ceftolozane/tazobactam (C/T) has established efficacy in clinical trials. This review aimed to collate data on C/T use in clinical practice. Methods This systematic literature review searched online biomedical databases for real-world studies of C/T for gram-negative infections up to June 2020. Relevant study, patient, and treatment characteristics, microbiology, and efficacy outcomes were captured. Results There were 83 studies comprising 3,701 patients were identified. The most common infections were respiratory infections (52.9% of reported infections), urinary tract infections (UTIs; 14.9%), and intra-abdominal infections (IAIs; 10.1%). Most patients included were seriously ill and had multiple comorbidities. The majority of patients had infections caused by P.aeruginosa (90.7%), of which 86.0% were antimicrobial-resistant. C/T was used as both a 1.5 g q8h and 3 g q8h dose, for a median duration of 7–56 days (varying between studies). Outcome rates were comparable between studies: clinical success rates ranged from 45.7 to 100.0%, with 27 studies (69%) reporting clinical success rates of > 70%; microbiological success rates ranged from 31 to 100%, with 14 studies (74%) reporting microbiological success rates of > 70%. Mortality rates ranged from 0 to 50%, with 31 studies (69%) reporting mortality rates of ≤ 20%. In comparative studies, C/T was as effective as aminoglycoside- or polymyxin-based regimens, and in some instances, significantly more effective. Conclusions The studies identified in this review demonstrate that C/T is effective in clinical practice, despite the diverse group of seriously ill patients, different levels of resistance of the pathogens treated, and varying dosing regimens used. Furthermore, comparative studies suggest that C/T offers a successful alternative to standard of care (SoC). Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-00933-8.
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Affiliation(s)
- Laura Puzniak
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA.
| | - Ryan Dillon
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA
| | - Thomas Palmer
- Adelphi Values PROVE, Adelphi Mill, Bollington, Cheshire, UK
| | - Hannah Collings
- Adelphi Values PROVE, Adelphi Mill, Bollington, Cheshire, UK
| | - Ashley Enstone
- Adelphi Values PROVE, Adelphi Mill, Bollington, Cheshire, UK
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15
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Stanić Benić M, Palčevski D, Milanič R, Skočibušić N, Abram M, Vlahović-Palčevski V. Does Fluoroquinolones and Third-Generation Cephalosporins Restriction Reverse Extended-Spectrum β-Lactamases Klebsiella pneumoniae Resistance Rates? Microb Drug Resist 2021; 27:1159-1166. [PMID: 33739871 DOI: 10.1089/mdr.2020.0301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Aim: To decrease the incidence and resistance rates of extended-spectrum β-lactamases (ESBL) Klebsiella pneumoniae (KP) by restriction of the use of third-generation cephalosporins (3GCs) and fluoroquinolones. Methods: Consumption of 3GCs, fluoroquinolones, and carbapenems in association with ertapenem and fluoroquinolone-resistant KP isolates, were analyzed in 21 months by autoregressive integrated moving average models. A follow-up analysis was performed 5 years later. Results: Consumption of 3GCs decreased significantly during the postintervention period. Their restriction was associated with a decrease in ertapenem-resistant KP isolates by 17.5%. Fluoroquinolone, 3GCs, and carbapenem use did not significantly predict the percentage of ertapenem-resistant KP isolates. Fluoroquinolone, but not cephalosporin use, significantly predicted the percentage of fluoroquinolone-resistant isolates, with an increase of 1 defined daily dose (DDD) of fluoroquinolone/100 occupied bed-days (OBDs) corresponding to a 0.32% increase of fluoroquinolone-resistant isolates (p = 0.008). A decrease of 1 DDD of carbapenem/100 OBD was associated with a 16.94% increase of fluoroquinolone-resistant isolates (p = 0.007). Five years later, the consumption of all three antimicrobial classes increased significantly compared with the 2011-2013 period, whereas ertapenem-resistant KP rates significantly decreased. Conclusion: This study may bring a valuable contribution to the understanding of the intricate association between antibiotic consumption and bacterial resistance. Reporting a spectrum of different results could present a useful basis for more profound research of various interventions' effects.
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Affiliation(s)
- Mirjana Stanić Benić
- Department of Clinical Pharmacology, and Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Dora Palčevski
- Department of Emergency, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Romina Milanič
- Department of Medical Area, University of Udine, Udine, Italy
| | - Nataša Skočibušić
- Department of Clinical Pharmacology, and Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Maja Abram
- Department of Clinical Microbiology, Clinical Hospital Center Rijeka, Croatia.,Department of Microbiology and Parasitology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Vera Vlahović-Palčevski
- Department of Clinical Pharmacology, and Clinical Hospital Center Rijeka, Rijeka, Croatia.,Department of Pharmacology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.,Department of Basic Medical Sciences, Faculty of Health Studies, University of Rijeka, Rijeka, Croatia
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16
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Ding Y, Wang H, Pu S, Huang S, Niu S. Resistance Trends of Klebsiella pneumoniae Causing Urinary Tract Infections in Chongqing, 2011-2019. Infect Drug Resist 2021; 14:475-481. [PMID: 33603411 PMCID: PMC7881772 DOI: 10.2147/idr.s295870] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 01/22/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose To analyze the characteristics and trends of drug resistance for Klebsiella pneumoniae (K. pneumoniae), isolated from urinary tract infections (UTIs), to common antibiotics used in clinics. Methods This retrospective study was conducted in a teaching hospital in Chongqing from 2011 to 2019. Laboratory data of isolated bacteria were collected and analyzed. Results Among the 17,966 non-repetitive strains isolated from the urine sample, a total of 1543 K. pneumoniae isolates were identified, with an isolation frequency secondary only to Escherichia coli (E. coli) and there was a peak in the K. pneumoniae isolates in the year 2013. During the period, the rate of extended-spectrum β-lactamase (ESBL)-producing K. pneumoniae fell from 48.4% in 2011 to 32.9% in 2019, and a marked jump of resistance was seen in carbapenems from 2.2% to 18.0%. The peak of carbapenem resistance rate (22.6%) to K. pneumoniae was observed in 2017 along with a low ESBL-producing rate (30.9%). Piperacillin/tazobactam and cefepime resistance levels went up from 4.4% to 25.7% and from 18.2% to 30.5%, respectively. Moreover, the K. pneumoniae isolates resistance rate to carbapenems and amikacin gradually grew up, showing their peaks in 2017, and then dropped year by year. However, ceftazidime and aztreonam resistance levels were relatively stable, fluctuating between 21.8% and 35.6%, 32.2% and 39.4%, respectively. Conclusion There is a significant upward tendency in carbapenem resistance rate and a downward tendency in ESBL-production rate in K. pneumoniae isolates from UTIs, and continuous surveillance is necessary in the future.
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Affiliation(s)
- Yanhui Ding
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Huijuan Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Shuli Pu
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Shifeng Huang
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Siqiang Niu
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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17
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Palacios-Baena ZR, Giannella M, Manissero D, Rodríguez-Baño J, Viale P, Lopes S, Wilson K, McCool R, Longshaw C. Risk factors for carbapenem-resistant Gram-negative bacterial infections: a systematic review. Clin Microbiol Infect 2021; 27:228-235. [PMID: 33130270 DOI: 10.1016/j.cmi.2020.10.016] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Rapid and widespread increases in carbapenem resistance (CR) necessitate identification of risk factors to guide appropriate interventions. OBJECTIVES We aimed to identify risk factors for CR Gram-negative infection through a systematic literature review. DATA SOURCES We searched MEDLINE (via OvidSP and PubMed) and Embase (via OvidSP) databases and the Cochrane Central Register of Controlled Trials. STUDY ELIGIBILITY CRITERIA Prospective or retrospective cohort and case-control studies reporting quantitative data on risk factors associated with infections due to CR Gram-negative pathogens in hospitalized patients were eligible. PARTICIPANTS Studies included hospitalized patients with CR infection caused by Gram-negative bacterial pathogens (Enterobacterales and non-fermenters). METHODS Searches were conducted in January 2018/December 2019 to identify studies published since 2007. Risk factor data were extracted and grouped by factor. The primary metric was proportion of studies reporting a significant association with CR infection for each factor. RESULTS In total, 92 studies were identified. Risk factors most frequently reported as significantly associated with CR infection (>10 studies) were previous antibiotic use (91.1%; 72/79 studies); previous carbapenem use (82.6%; 57/69); previous colonization (72.7%; 8/11); mechanical ventilation (66.7%; 36/54); previous intensive care unit stay (64.4%; 38/59); dialysis (61.1%; 11/18); catheter (58.0%; 40/69); length of stay in hospital (54.5%; 30/55); comorbidities (52.7%; 39/74); APACHE II (51.7%; 15/29); and intubation (51.4%; 18/35). Risk factors were mostly consistent across different species and sites of infection. CONCLUSIONS Several variables, particularly previous antibiotic use, are strong risk factors for CR infection. Interventions to mitigate against CR infection should target these factors.
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Affiliation(s)
- Zaira R Palacios-Baena
- Infectious Diseases, Clinical Microbiology and Preventive Medicine Unit, Hospital Universitario Virgen Macarena, Institute of Biomedicine of Seville (IBIS), Seville, Spain.
| | - Maddalena Giannella
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Davide Manissero
- Medical Affairs for Infection and Immune Diagnostics, QIAGEN, London, UK
| | | | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Sara Lopes
- Market Access, Shionogi Europe, London, UK
| | - Katy Wilson
- York Health Economics Consortium, University of York, York, UK
| | - Rachael McCool
- York Health Economics Consortium, University of York, York, UK
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18
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Innate Immune Effectors Play Essential Roles in Acute Respiratory Infection Caused by Klebsiella pneumoniae. J Immunol Res 2020; 2020:5291714. [PMID: 33163539 PMCID: PMC7607282 DOI: 10.1155/2020/5291714] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/16/2020] [Accepted: 10/12/2020] [Indexed: 12/24/2022] Open
Abstract
Innate immune effectors constitute the first line of host defense against pathogens. However, the roles of these effectors are not clearly defined during Klebsiella pneumoniae (K. pneumoniae) respiratory infection. In the current study, we established an acute pneumonia model of K. pneumoniae respiratory infection in mice and confirmed that the injury was most severe 48 h post infection. Flow cytometric assay demonstrated that alveolar macrophages were the predominant cells in BALF before infection, and neutrophils were quickly recruited after infection, and this was in consistent with the kinetics of chemokine expression. Further, we depleted neutrophils, macrophages, and complement pathways in vivo and challenged these mice with a sublethal dose of K. pneumonia, the result showed that 80%, 60%, and 40% of mice were died in these groups, respectively, while no deaths occurred in the control group. Besides, innate immune effector depleted mice showed higher bacterial burdens in lungs and blood, companied with more severe lung damage and increased levels of cytokine/chemokine expression. These results demonstrated that the innate immune effectors are critical in the early controlling of K. pneumoniae infection, and neutrophils are the most important. Thus, alternative strategies targeting these innate immune effectors may be effective in controlling of K. pneumoniae respiratory infection.
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19
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Lima EM, Cid PA, Beck DS, Pinheiro LHZ, Tonhá JPS, Alves MZO, Lourenço ND, Santos RQ, Asensi MD, Marques JA, Bandeira CS, Rodrigues CAS, Gomes Junior SCS, Gomes MZR. Predictive factors for sepsis by carbapenem resistant Gram-negative bacilli in adult critical patients in Rio de Janeiro: a case-case-control design in a prospective cohort study. Antimicrob Resist Infect Control 2020; 9:132. [PMID: 32795380 PMCID: PMC7426895 DOI: 10.1186/s13756-020-00791-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/26/2020] [Indexed: 12/14/2022] Open
Abstract
Background Studies have investigated risk factors for infections by specific species of carbapenem-resistant Gram-negative bacilli (CR-GNB), but few considered the group of GNB species and most of them were performed in the setting of bacteremia or hospital infection. This study was implemented to identify risk factors for sepsis by CR- and carbapenem-susceptible (CS) GNB in intensive care unit (ICU) patients to improve management strategies for CR-GNB sepsis. Methods We developed a case-case-control study from a prospective cohort of patients with systemic inflammatory response syndrome (SIRS), sepsis-2 or sepsis-3 criteria in which blood and other sample cultures were collected and antimicrobial therapy was instituted, in an adult clinical-surgical ICU, at tertiary public hospital in Rio de Janeiro, from August 2015 through March 2017. Results Among the total of 629 ICU admissions followed by 7797 patient-days, after applying inclusion and exclusion criteria we identified 184 patients who developed recurrent or single hospital-acquired sepsis. More than 90% of all evaluable cases of sepsis and 87% of control group fulfilled the modified sepsis-3 definition. Non-fermenting bacilli and ventilator-associated pneumonia predominated as etiology and source of CR-GNB sepsis. While Enterobacteriaceae and intra-abdominal surgical site plus urinary-tract infections prevailed in CS-GNB than CR-GNB sepsis. Carbapenemase production was estimated in 76% of CR-GNB isolates. Multivariate logistic regression analysis revealed previous infection (mostly hospital-acquired bacterial infection or sepsis) (OR = 4.28; 95% CI 1.77–10.35), mechanical ventilation (OR = 4.21; 95% CI 1.17–15.18), carbapenem use (OR = 3.42; 95% CI 1.37–8.52) and length of hospital stay (OR = 1.03; 95% CI 1.01–1.05) as independent risk factors for sepsis by CR-GNB. While ICU readmission (OR = 6.92; 95% CI 1.72–27.78) and nosocomial diarrhea (OR = 5.32; 95% CI 1.07–26.45) were factors associated with CS-GNB sepsis. Conclusions The investigation of recurrent and not only bacteremic episodes of sepsis was the differential of this study. The results are in agreement with the basic information in the literature. This may help improve management strategies and future studies on sepsis by CR-GNB.
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Affiliation(s)
- Elisangela M Lima
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro, RJ, Brazil.,Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - Patrícia A Cid
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Debora S Beck
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Luiz Henrique Z Pinheiro
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - João Pedro S Tonhá
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Marcio Z O Alves
- Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - Newton D Lourenço
- Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - Roberto Q Santos
- Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - Marise D Asensi
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - José Aurélio Marques
- Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - Carolina S Bandeira
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Caio Augusto S Rodrigues
- Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | | | - Marisa Z R Gomes
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro, RJ, Brazil. .,Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro, RJ, Brazil. .,Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro, RJ, Brazil.
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20
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Yuan Y, Wang J, Yao Z, Ma B, Li Y, Yan W, Wang S, Ma Q, Zhang J, Xu J, Li L, Wang Y, Fan E. Risk Factors for Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infections and Outcomes. Infect Drug Resist 2020; 13:207-215. [PMID: 32158236 PMCID: PMC6985980 DOI: 10.2147/idr.s223243] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 01/07/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The incidence of carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections (BSIs) is increasing globally; however, little has been reported on the risk factors and outcomes of CRKP BSIs in central China. This study aimed to determine the clinical risk factors for CRKP BSIs and the outcomes of CRKP BSIs. Patients and Methods We performed a case-control study of 239 patients with K. pneumoniae BSIs who were treated at Henan Provincial People’s Hospital between July 2017 and July 2018. The cases (n=98, 41%) had CRKP BSIs, and the controls (n=141, 59%) had non-carbapenem-resistant K. pneumoniae (non-CRKP) BSIs. Antimicrobial sensitivity was determined using automated broth microdilution and an agar disk diffusion method. Data were obtained from clinical and laboratory records. Multivariate logistic regression and Pearson chi-square tests were used to identify clinical factors and outcomes associated with carbapenem resistance. Results Risk factors for carbapenem resistance included recent carbapenem use (odds ratio [OR]: 9.98, 95% confidence interval [CI]: 5.2–17.1, P<0.001), invasive procedures (OR: 11.1, 95% CI: 3.3–37.7, P<0.001), and pre-existing diseases of the digestive system (OR: 8.22, 95% CI: 1.73–39.2, P=0.008). Treatment failure was more frequent in the cases (84.7%) than in the controls (32.6%). Conclusion Exposure to antibiotics, especially carbapenems, and invasive procedures were the major risk factors for carbapenem resistance among patients with K. pneumoniae BSIs. Strict control measures should be implemented to prevent the emergence and spread of CRKP.
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Affiliation(s)
- Youhua Yuan
- Department of Clinical Microbiology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, and People's Hospital of Henan University, Zhengzhou, Henan 450003, People's Republic of China
| | - Junjie Wang
- Clinical Laboratory, Luyi Zhenyuan Hospital, Zhoukou, Henan 477200, People's Republic of China
| | - Zonghui Yao
- Department of Clinical Microbiology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, and People's Hospital of Henan University, Zhengzhou, Henan 450003, People's Republic of China
| | - Bing Ma
- Department of Clinical Microbiology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, and People's Hospital of Henan University, Zhengzhou, Henan 450003, People's Republic of China
| | - Yi Li
- Department of Clinical Microbiology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, and People's Hospital of Henan University, Zhengzhou, Henan 450003, People's Republic of China
| | - Wenjuan Yan
- Department of Clinical Microbiology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, and People's Hospital of Henan University, Zhengzhou, Henan 450003, People's Republic of China
| | - Shanmei Wang
- Department of Clinical Microbiology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, and People's Hospital of Henan University, Zhengzhou, Henan 450003, People's Republic of China
| | - Qiong Ma
- Department of Clinical Microbiology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, and People's Hospital of Henan University, Zhengzhou, Henan 450003, People's Republic of China
| | - Jiangfeng Zhang
- Department of Clinical Microbiology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, and People's Hospital of Henan University, Zhengzhou, Henan 450003, People's Republic of China
| | - Junhong Xu
- Department of Clinical Microbiology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, and People's Hospital of Henan University, Zhengzhou, Henan 450003, People's Republic of China
| | - Li Li
- Department of Clinical Microbiology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, and People's Hospital of Henan University, Zhengzhou, Henan 450003, People's Republic of China
| | - Yuming Wang
- Department of Clinical Microbiology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, and People's Hospital of Henan University, Zhengzhou, Henan 450003, People's Republic of China
| | - Enguo Fan
- Department of Clinical Microbiology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, and People's Hospital of Henan University, Zhengzhou, Henan 450003, People's Republic of China
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21
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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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22
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Li J, Li Y, Song N, Chen Y. Risk factors for carbapenem-resistant Klebsiella pneumoniae infection: A meta-analysis. J Glob Antimicrob Resist 2019; 21:306-313. [PMID: 31525540 DOI: 10.1016/j.jgar.2019.09.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/21/2019] [Accepted: 09/07/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Rates of nosocomial infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) have increased. A meta-analysis was conducted to explore risk factors for CRKP infection in order to provide a theoretical basis for reducing the CRKP infection rate and actively preventing CRKP infection. METHODS Online databases, including PubMed, EMBASE, OVID, ClinicalKey, CNKI, CBM, Wanfang Database and CHKD, were searched from inception up to 31 October 2018 for articles regarding risk factors for CRKP infection. Relevant articles were retrieved, supplemented by retrospective and manual search literature. RevMan 5.3 software was used for statistical analysis. RESULTS A total of 30 articles comprising 5075 cases were included in the study, of which 24 were in English and 6 were in Chinese. The results showed that age, sex and diabetes mellitus were not associated with CRKP infection. The odds ratio (95% confidence interval) of risk factors for CRKP infection were as follows: immunosuppression, 1.47 (1.14-1.90); ICU admission, 3.25 (2.36-4.47); antibiotic exposure, 2.53 (1.56-4.11); carbapenem exposure, 3.99 (2.86-5.56); quinolone exposure, 1.75 (1.38-2.22); glycopeptide exposure, 3.08 (1.93-4.91); β‑lactam/β‑lactamase inhibitor (BL/BLI) exposure, 2.28 (1.37-3.80); surgery, 1.59 (1.08-2.34); mechanical ventilation, 2.91 (1.96-4.31); central venous catheterisation, 2.93 (2.00-4.28); indwelling catheter, 2.62 (1.65-4.17); and nasogastric intubation, 2.38 (1.22-4.62). CONCLUSION Immunosuppression, ICU admission, antibiotic exposure (including carbapenems, quinolones, glycopeptides and BL/BLIs), surgery, mechanical ventilation, central venous catheterisation, indwelling catheter and nasogastric intubation were identified as risk factors for CRKP infection and should to be considered in clinical practice.
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Affiliation(s)
- Jihong Li
- Department of Laboratory Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yuanyuan Li
- Department of Infectious Diseases, The Second Hospital of Hebei Medical University, No. 215 Heping Western Road, Xinhua District, Shijiazhuang 050000, Hebei, China
| | - Ning Song
- Department of Infectious Diseases, The Second Hospital of Hebei Medical University, No. 215 Heping Western Road, Xinhua District, Shijiazhuang 050000, Hebei, China.
| | - Yuan Chen
- Department of Pediatrics, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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23
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Zhao X, Wang L, Wei N, Zhang J, Ma W, Zhao H, Han X. Risk factors of health care-associated infection in elderly patients: a retrospective cohort study performed at a tertiary hospital in China. BMC Geriatr 2019; 19:193. [PMID: 31324235 PMCID: PMC6642591 DOI: 10.1186/s12877-019-1208-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/10/2019] [Indexed: 12/16/2022] Open
Abstract
Background The elderly inpatients are in high risk of suffering health-care associated infection (HAI). The study aimed to analyze the risk factors of health-care associated infection (HAI) in elderly hospitalized patients to prevent it and improve the recovery rate of elderly patients. Methods The study was a Retrospective Cohort Study based on a 3-year surveillance in elderly inpatients in a large tertiary hospital in China. A retrospective review of the elderly inpatients ≥60 years with or without HAI were conducted. Binary multivariable logistic regression was used to evaluate the potential association between HAI and risk factors. Results We investigated a total of 60,332 subjects aged 60 years old or above. The incidence of HAI in elderly was 2.62%. With adjustment for some factors, advanced age, hospital days before HAI, intensive care unit (ICU) admission, use of ventilator, central line catheter or urinary catheter and cerebral hemorrhage, cerebral infarction, brain neoplasms, diabetes mellitus, coronary artery disease, malignant tumor and malignant hematonosis had significantly increased odds ratios (OR) of suffering from HAI compared with the control group but body weight and operation decreased OR. Conclusion Our findings suggested that advanced age, accompanied by some neurological and chronic noncommunicable diseases, hospital days before HAI, ICU admission, and use of devices were risk factors of suffering HAI in the elderly but the body weight and operation were the potential protective factors in this sample.
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Affiliation(s)
- Xia Zhao
- Hospital Infection Management Division, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Lihong Wang
- Hospital Infection Management Division, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China.
| | - Nan Wei
- School of Health Management and Education, Capital Medical University, Beijing, China
| | - Jingli Zhang
- Hospital Infection Management Division, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Wenhui Ma
- Hospital Infection Management Division, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Huijie Zhao
- Hospital Infection Management Division, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Xu Han
- Hospital Infection Management Division, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
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Wang Z, Qin RR, Huang L, Sun LY. Risk Factors for Carbapenem-resistant Klebsiella pneumoniae Infection and Mortality of Klebsiella pneumoniae Infection. Chin Med J (Engl) 2019; 131:56-62. [PMID: 29271381 PMCID: PMC5754959 DOI: 10.4103/0366-6999.221267] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Klebsiella pneumoniae (KP) is a pathogen commonly causing nosocomial infection. Carbapenem-resistant KP (CRKP) is more resistant to multiple antimicrobial drugs than carbapenem-susceptible KP (CSKP) isolates. The aim of the present study was to identify the risk factors for CRKP infection and the predictors of mortality among KP-infected adult patients. Methods: Patients with CRKP and CSKP infection were categorized as the case group and control group, respectively, and we conducted a 1:1 ratio case-control study on these groups. The CRKP isolates collected were tested for antimicrobial susceptibility and presence of KP carbapenemase (KPC) gene. Clinical data were collected to identify risk factors for CRKP infection and mortality of KP infection. Risk factors were analyzed under univariable and multivariable logistic regression model. Results: The independent risk factors for CRKP infection were admission to Intensive Care Unit (odds ratio [OR]: 15.486, 95% confidence interval [CI]: 3.175–75.541, P < 0.001); use of β-lactams and β-lactamase inhibitor combination (OR: 4.765, 95% CI: 1.508–15.055, P = 0.008); use of cephalosporins (OR: 8.033, 95% CI: 1.623–39.763, P = 0.011); fluoroquinolones (OR: 6.090, 95% CI: 1.343–27.613, P = 0.019); and indwelling of urethral catheter (OR: 6.164, 95% CI: 1.847–20.578, P = 0.003). However, older age (OR: 1.079, 95% CI: 1.005–1.158, P = 0.036), Charlson comorbidity index (OR: 4.690, 95% CI: 2.094–10.504, P = 0.000), and aminoglycoside use (OR: 670.252, 95% CI: 6.577–68,307.730, P = 0.006) were identified as independent risk factors for patient deaths with KP infection. The mortality of CRKP group was higher than that of the CSKP group. KPC gene did not play a role in the CRKP group. CRKP mortality was high. Conclusion: Implementation of infection control measures and protection of the immunefunction are crucial.
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Affiliation(s)
- Zhe Wang
- Department of Clinical Laboratory, Peking University First Hospital, Beijing 100034, China
| | - Ran-Ran Qin
- Graduate School, Peking University Health Science Center, Beijing 100083, China
| | - Lei Huang
- Department of Clinical Laboratory, Peking University First Hospital, Beijing 100034, China
| | - Li-Ying Sun
- Department of Clinical Laboratory, Peking University First Hospital, Beijing 100034, China
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Abdallah M, Badawi M, Alzaagi I, Issa KN, Rasheed A, Alharthy A. Effect of short-term carbapenem restriction on the incidence of non-pseudomonal multi-drug resistant Gram-negative bacilli in an intensive care unit. J Chemother 2019; 31:261-266. [PMID: 30983552 DOI: 10.1080/1120009x.2019.1601802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We conducted a two-phase retrospective study to investigate the impact of a short-term carbapenem restriction on the incidence of non-pseudomonal multidrug-resistant (MDR) Gram-negative bacilli in our intensive care unit (ICU). The first phase of the study (before carbapenem restriction) was conducted between May and July 2016, and the second phase (implementation of carbapenem restriction) between September and November 2016. The incidence of all non-pseudomonal MDR Gram-negative bacilli (extended-spectrum β-lactamase-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae and MDR Acinetobacter baumannii) decreased significantly after carbapenem restriction. Patients positive for non-pseudomonal MDR Gram-negative bacilli before and after carbapenem restriction were comparable in terms of age, weight, Acute Physiology and Chronic Health Evaluation IV score, central venous catheter placement, and vasopressor use. This report suggests that short-term carbapenem restriction for 3 months may be an effective strategy for reducing the incidence of non-pseudomonal MDR Gram-negative bacilli.
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Affiliation(s)
- Mohammad Abdallah
- Pharmaceutical Care Services, King Saud Medical City , Riyadh , Saudi Arabia
| | - Mohammad Badawi
- Prevention and Control of Infection Administration, King Saud Medical City , Riyadh , Saudi Arabia
| | - Ibrahim Alzaagi
- Pharmaceutical Care Services, King Saud Medical City , Riyadh , Saudi Arabia
| | | | - Akram Rasheed
- Nursing Department, King Saud Medical City , Riyadh , Saudi Arabia
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ESBL-colonization at ICU admission: impact on subsequent infection, carbapenem-consumption, and outcome. Infect Control Hosp Epidemiol 2019; 40:408-413. [PMID: 30786948 DOI: 10.1017/ice.2019.5] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine whether colonization with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) predicts the risk for subsequent infection and impacts carbapenem-consumption and outcome in intensive care unit (ICU) patients. DESIGN Prospective cohort study. SETTING The 2 ICUs in the University Hospital Basel in Switzerland. PATIENTS All patients admitted to the 2 ICUs providing mechanical ventilation and an expected ICU stay >48 hours. METHODS Patients were routinely screened for ESBL-PE carriage by rectal swab on admission. Competing risk regression analyses were applied to calculate hazard ratios (HRs) for infection with ESBL-PE and mortality. Length of hospital stay, length of ICU stay, and duration of carbapenem exposure were compared using the Mann-Whitney U test. RESULTS Among 302 patients, 24 (8.0%) were colonized with ESBL-PE on ICU admission. Infections with ESBL-PE occurred in 4 patients, of whom 3 (75%) were identified as ESBL-PE colonized on admission. ESBL-PE colonization on admission was associated with subsequent ESBL-PE infection (hazard ratio [HR], 25.52; 95% confidence interval [CI], 2.40-271.41; P = .007) and exposure to carbapenems (HR, 2.42; 95% CI, 1.01-5.79; P = .047), whereas duration of carbapenem exposure did not differ in relation to ESBL-PE colonization (median, 7 days [IQR, 3-8 days] vs median, 6 days [IQR 3-9 days]; P = 0.983). Patients colonized with ESBL-PE were not at increased risk for death overall (HR, 1.00; 95% CI, 0.44-2.30; P = .993) or death attributable to infection (HR, 1.20; 95% CI, 0.28-5.11; P = .808). CONCLUSIONS Screening strategies for detection of ESBL-PE colonization on ICU admission may allow the identification of patients at highest risk for ESBL-PE infection and the correct allocation of empiric carbapenem treatment.
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Risk Factors for Carbapenem Resistant Klebsiella pneumoniae Hospital Infection in the Intensive Care Unit. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2018. [DOI: 10.2478/sjecr-2018-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Carbapenem-resistant Klebsiella pneumoniae (CR-Kp) has become a major threat to patients in hospitals, increasing mortality, length of stay and costs.
The aim of this study was to discover risk factors for the development of hospital infections (HIs) caused by CR-Kp.
A prospective cohort study was conducted in the Medical-Surgical Intensive Care Unit of the Clinical Centre in Kragujevac, Kragujevac, Serbia, from January 1, 2011, to December 31, 2015. The “cases” were patients with HIs caused by CR-Kp, while the “controls” were patients infected with carbapenem-sensitive Klebsiella pneumoniae (CS-Kp). The significance of multiple putative risk factors for HIs caused by CR-Kp was tested using multivariate logistic regression.
Although univariate analyses pointed to many risk factors, with a significant influence on the occurrence of hospital CR-Kp infections, the multivariate logistic regression identified five independent risk factors: use of mechanical ventilation (OR=6.090; 95% CI=1.030-36.020; p=0.046); length of antibiotic therapy before HIs (days) (OR=1.080; 95% CI=1.003-1.387; p=0.045); previous use of carbapenems (OR=7.005; 95% CI=1.054-46.572; p=0.044); previous use of ciprofloxacin (OR=20.628; 95% CI=2.292-185.687; p=0.007) and previous use of metronidazole (OR=40.320; 95% CI=2.347-692.795; p=0.011)
HIs caused by CR-Kp are strongly associated with the use of mechanical ventilation and the duration of the previous use of certain antibiotics (carbapenems, ciprofloxacin and metronidazole).
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Liu P, Li X, Luo M, Xu X, Su K, Chen S, Qing Y, Li Y, Qiu J. Risk Factors for Carbapenem-Resistant Klebsiella pneumoniae Infection: A Meta-Analysis. Microb Drug Resist 2018; 24:190-198. [PMID: 28749714 PMCID: PMC5873294 DOI: 10.1089/mdr.2017.0061] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIMS Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection has been rapidly emerging as a life-threatening nosocomial disease in many countries. However, studies on the corresponding risk factors of CRKP infection showed inconsistent results. To resolve these inconsistencies, we conducted a meta-analysis of previous studies on the potential risk factors of CRKP infection. The results of this study could be used to develop CRKP infection prevention strategies. METHODS Relevant works were systematically searched from five electronic databases up to September 2016. Z-test was used to determine the significance of the pooled odds ratios (ORs). ORs and 95% confidence intervals were utilized to compare the risk factors of CRKP infection. RESULTS Sixteen studies that involved 3,627 participants were included in the meta-analysis. We identified the following risk factors that were associated with CRKP infection: (1) longer length of hospital stay (LOS) (OR = 12.92), (2) admission to intensive care unit (ICU) (OR = 2.48), (3) prior hospitalization (OR = 1.85), (4) longer days of ICU stay (OR = 4.58), (5) transplant recipient (OR = 2.01), (6) steroid use (OR = 1.43), (7) central venous catheter use (OR = 2.30), (8) mechanical ventilation (OR = 2.54), (9) presence of tracheostomy (OR = 3.63), (10) parenteral nutrition (OR = 2.38), (11) previous antibiotic use (OR = 3.31), and (12) exposure to carbapenems (OR = 4.01), (13) aminoglycosides (OR = 2.05), (14) glycopeptides (OR = 2.40), (15) quinolones (OR = 2.28), and (16) anti-pseudomonal penicillins (OR = 2.67). CONCLUSIONS Sixteen risk factors including longer LOS, admission to ICU, previous antibiotic use, and exposure to carbapenems were associated with the development of CRKP infection. Identification of modifiable risk factors could play an important role in the prevention of CRKP infection.
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Affiliation(s)
- Pin Liu
- School of Public Health and Management, Chongqing Medical University , Chongqing, China
| | - Xuan Li
- School of Public Health and Management, Chongqing Medical University , Chongqing, China
| | - Mei Luo
- School of Public Health and Management, Chongqing Medical University , Chongqing, China
| | - Xuan Xu
- School of Public Health and Management, Chongqing Medical University , Chongqing, China
| | - Kewen Su
- School of Public Health and Management, Chongqing Medical University , Chongqing, China
| | - Shuai Chen
- School of Public Health and Management, Chongqing Medical University , Chongqing, China
| | - Ying Qing
- School of Public Health and Management, Chongqing Medical University , Chongqing, China
| | - Yingli Li
- School of Public Health and Management, Chongqing Medical University , Chongqing, China
| | - Jingfu Qiu
- School of Public Health and Management, Chongqing Medical University , Chongqing, China
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Risk factors for acquisition of OXA-48-producing Klebsiella pneumonia among contact patients: a multicentre study. J Hosp Infect 2018; 98:253-259. [DOI: 10.1016/j.jhin.2017.08.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 08/29/2017] [Indexed: 11/20/2022]
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van Loon K, Voor In 't Holt AF, Vos MC. A Systematic Review and Meta-analyses of the Clinical Epidemiology of Carbapenem-Resistant Enterobacteriaceae. Antimicrob Agents Chemother 2018; 62:e01730-17. [PMID: 29038269 PMCID: PMC5740327 DOI: 10.1128/aac.01730-17] [Citation(s) in RCA: 145] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/29/2017] [Indexed: 01/23/2023] Open
Abstract
Carbapenem-resistant Enterobacteriaceae (CRE) are major health care-associated pathogens and responsible for hospital outbreaks worldwide. To prevent a further increase in CRE infections and to improve infection prevention strategies, it is important to summarize the current knowledge about CRE infection prevention in hospital settings. This systematic review aimed to identify risk factors for CRE acquisition among hospitalized patients. In addition, we summarized the environmental sources/reservoirs and the most successful infection prevention strategies related to CRE. A total of 3,983 potentially relevant articles were identified and screened. Finally, we included 162 studies in the systematic review, of which 69 studies regarding risk factors for CRE acquisition were included in the random-effects meta-analysis studies. The meta-analyses regarding risk factors for CRE acquisition showed that the use of medical devices generated the highest pooled estimate (odds ratio [OR] = 5.09; 95% confidence interval [CI] = 3.38 to 7.67), followed by carbapenem use (OR = 4.71; 95% CI = 3.54 to 6.26). To control hospital outbreaks, bundled interventions, including the use of barrier/contact precautions for patients colonized or infected with CRE, are needed. In addition, it is necessary to optimize the therapeutic approach, which is an important message to infectious disease specialists, who need to be actively involved in a timely manner in the treatment of patients with known CRE infections or suspected carriers of CRE.
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Affiliation(s)
- Karlijn van Loon
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Anne F Voor In 't Holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Founou RC, Founou LL, Essack SY. Clinical and economic impact of antibiotic resistance in developing countries: A systematic review and meta-analysis. PLoS One 2017; 12:e0189621. [PMID: 29267306 PMCID: PMC5739407 DOI: 10.1371/journal.pone.0189621] [Citation(s) in RCA: 333] [Impact Index Per Article: 47.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 11/28/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Despite evidence of the high prevalence of antibiotic resistant infections in developing countries, studies on the clinical and economic impact of antibiotic resistance (ABR) to inform interventions to contain its emergence and spread are limited. The aim of this study was to analyze the published literature on the clinical and economic implications of ABR in developing countries. METHODS A systematic search was carried out in Medline via PubMed and Web of Sciences and included studies published from January 01, 2000 to December 09, 2016. All papers were considered and a quality assessment was performed using the Newcastle-Ottawa quality assessment scale (NOS). RESULTS Of 27 033 papers identified, 40 studies met the strict inclusion and exclusion criteria and were finally included in the qualitative and quantitative analysis. Mortality was associated with resistant bacteria, and statistical significance was evident with an odds ratio (OR) 2.828 (95%CI, 2.231-3.584; p = 0.000). ESKAPE pathogens was associated with the highest risk of mortality and with high statistical significance (OR 3.217; 95%CIs; 2.395-4.321; p = 0.001). Eight studies showed that ABR, and especially antibiotic-resistant ESKAPE bacteria significantly increased health care costs. CONCLUSION ABR is associated with a high mortality risk and increased economic costs with ESKAPE pathogens implicated as the main cause of increased mortality. Patients with non-communicable disease co-morbidities were identified as high-risk populations.
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Affiliation(s)
- Raspail Carrel Founou
- Antimicrobial Research Unit, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Clinical Microbiology, Centre of Expertise and Biological Diagnostic of Cameroon, Yaoundé, Cameroon
| | - Luria Leslie Founou
- Antimicrobial Research Unit, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Food Safety and Environmental Microbiology, Centre of Expertise and Biological Diagnostic of Cameroon, Yaoundé, Cameroon
| | - Sabiha Yusuf Essack
- Antimicrobial Research Unit, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Candevir Ulu A, Güven Gökmen T, Kibar F, Kurtaran B, Önlen C, Kuşçu F, İnal AS, Kömür S, Yaman A, Aksu HSZ, Taşova Y. Molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae at a Turkish centre: Is the increase of resistance a threat for Europe? J Glob Antimicrob Resist 2017; 11:10-16. [DOI: 10.1016/j.jgar.2017.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/15/2017] [Accepted: 06/21/2017] [Indexed: 12/18/2022] Open
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Pilmis B, Jullien V, Tabah A, Zahar JR, Brun-Buisson C. Piperacillin-tazobactam as alternative to carbapenems for ICU patients. Ann Intensive Care 2017; 7:113. [PMID: 29127502 PMCID: PMC5681454 DOI: 10.1186/s13613-017-0334-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 10/26/2017] [Indexed: 12/19/2022] Open
Abstract
Several studies suggest that alternatives to carbapenems, and particulary beta-lactam/beta-lactamase inhibitor combinations, can be used for therapy of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE)-related infections in non-ICU patients. Little is known concerning ICU patients in whom achieving the desired plasmatic pharmacokinetic/pharmacodynamic (PK/PD) target may be difficult. Also, in vitro susceptibility to beta-lactamase inhibitors might not translate into clinical efficacy. We reviewed the recent clinical studies examining the use of BL/BLI as alternatives to carbapenems for therapy of bloodstream infection, PK/PD data and discuss potential ecological benefit from avoiding the use of carbapenems. With the lack of prospective randomized studies, treating ICU patients with ESBL-PE-related infections using piperacillin-tazobactam should be done with caution. Current data suggest that BL/BLI empirical use should be avoided for therapy of ESBL-PE-related infection. Also, definitive therapy should be reserved to patients in clinical stable condition, after microbial documentation and results of susceptibility tests. Optimization of administration and higher dosage should be used in order to reach pharmacological targets.
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Affiliation(s)
- Benoit Pilmis
- Service de maladies infectieuses et tropicales, Hôpital Necker Enfants malades, Service de maladies infectieuses et tropicales, Université Paris Descartes, Paris, France.,Equipe mobile de microbiologie clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Vincent Jullien
- Service de Pharmacologie, Hôpital Européen Georges Pompidou, Université Paris Descartes, Paris, France.,INSERM U1129, Paris, France
| | - Alexis Tabah
- Intensive Care Unit, The Redcliffe Hospital, Brisbane, Australia.,Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia
| | - Jean-Ralph Zahar
- Département de Microbiologie Clinique, Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, CHU Avicenne, 125 rue de Stalingrad, 9300, Bobigny, France. .,Infection Control Unit, IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, Paris, France.
| | - Christian Brun-Buisson
- Réanimation médicale, Hôpital Henri Mondor, Université Paris Est Créteil (UPEC), Créteil, France
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Lavagnoli LS, Bassetti BR, Kaiser TDL, Kutz KM, Cerutti C. Factors associated with acquisition of carbapenem-resistant Enterobacteriaceae. Rev Lat Am Enfermagem 2017; 25:e2935. [PMID: 29020126 PMCID: PMC5635698 DOI: 10.1590/1518-8345.1751.2935] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 06/27/2017] [Indexed: 01/12/2023] Open
Abstract
Objective: to identify possible risk factors for acquisition of Enterobacterial strains with
a marker for resistance to carbapenems. Methods: exploratory case-control study performed in hospital settings. The study sample
consisted of patients with biological specimens that tested positive for
carbapenem-resistant Enterobacteriaceae (cases), with the disk diffusion test and
Etest, and controls with biological samples testing negative for
carbapenem-resistant Enterobacteriaceae. In all, 65 patients were included: 13
(20%) cases and 52 (80%) controls. Results: the microorganisms isolated were Serratia marcescens (6), Klebsiella pneumoniae
(4), and Enterobacter cloacae (3). Univariate analysis revealed that length of
hospitalization prior to sample collection (p=0.002) and having a surgical
procedure (p=0.006) were statistically significant. In the multivariable logistic
regression model, both were still significant, with odds ratios of 0.93 (p =
0.009; 95% CI: 0.89 to 0.98) for length of hospitalization prior to sample
collection, and 9.28 (p = 0.05; 95% CI: 1.01 to 85.14) for having a surgical
procedure. Conclusion: shorter hospitalization times and increased surveillance of patients undergoing
surgery could play a decisive role in reducing the spread of carbapenem-resistant
microorganisms in hospital settings.
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Affiliation(s)
- Lilian Silva Lavagnoli
- MSc, Microbiologist, Laboratório de Microbiologia Médica, Secretaria de Saúde, Vitória, ES, Brazil
| | - Bil Randerson Bassetti
- Physician, Hospital Estadual Central, Vitória, ES, Brazil. Physician, Hospital Santa Casa de Misericóridia de Vitória, Vitória, ES, Brazil
| | - Thais Dias Lemos Kaiser
- MSc, Microbiologist, Laboratório de Microbiologia Médica, Secretaria de Saúde, Vitória, ES, Brazil
| | - Kátia Maria Kutz
- Specialist in Applied Microbiology, Microbiologist, Hospital Santa Casa de Misericóridia de Vitória, Vitória, ES, Brazil
| | - Crispim Cerutti
- PhD, Associate Professor, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
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Zheng X, Wang JF, Xu WL, Xu J, Hu J. Clinical and molecular characteristics, risk factors and outcomes of Carbapenem-resistant Klebsiella pneumoniae bloodstream infections in the intensive care unit. Antimicrob Resist Infect Control 2017; 6:102. [PMID: 29026535 PMCID: PMC5625719 DOI: 10.1186/s13756-017-0256-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/04/2017] [Indexed: 11/10/2022] Open
Abstract
Background To analyze the clinical characteristics and outcomes of carbapenem-resistant Klebsiella pneumoniae (CRKp) and carbapenem-susceptible K. pneumoniae (CSKp) bloodstream infections (BSIs), and to study the risk factors for development of CRKp BSI and K. pneumoniae BSI-related mortality. Methods A retrospective case control study of patients with K. pneumoniae BSI was conducted in the intensive care unit of the First Affiliated Hospital, Medical of College, Zhejiang University from January 2013 to December 2014. Carbapenem resistance was defined in accordance with the Clinical and Laboratory Standards Institute 2016 guidelines. Risk factors for the development of CRKp BSI and risk factors for mortality due to K. pneumoniae BSI were assessed. Virulence genes were detected by polymerase chain reaction assay. Results In total, 48 patients were enrolled in the study, including 31 (65%) patients with CRKp BSI and 17 (35%) patients with CSKp BSI. CSKp infection was associated with more severe clinical symptoms, particularly a higher serum creatinine level (165.06 ± 127.01 in the CSKp group vs. 93.77 ± 84.35 μmol/L in the CRKp group, p = 0.039), but there was no significant difference in prognosis between the CSKp and CRKp groups. On multivariate analysis, indwelling central venous catheter (p = 0.045) was the only factor independently associated with CRKp bacteremia. However, the mortality of K. pneumoniae BSI patients was not correlated with carbapenem resistance. In addition, the isolates had diverse clonality and different origins. The frequency of detection of the allS and magA virulence genes was higher in the CSKp group than in the CRKp group (alls p = 0.04; magA p = 0.047). Conclusions Patients in the CSKp group experienced more severe clinical symptoms, although mortality did not differ significantly between the CRKp and CSKp groups. An indwelling central venous catheter was the only factor independently associated with CRKp BSI. The mortality of patients with K. pneumoniae BSI was not associated with carbapenem resistance. The frequency of virulence genes was higher in the CSKp group than in the CRKp group.
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Affiliation(s)
- Xia Zheng
- Intensive Care Unit, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003 People's Republic of China
| | - Jian-Feng Wang
- Department of Respiratory Diseases, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, No. 126 Wenzhou Road, Hangzhou, 310009 People's Republic of China
| | - Wang-Lan Xu
- Intensive Care Unit, Hospital of Zhejiang General Corps of Armed Police Forces, No. 16 Nanhu Road, Jiaxing, 314000 Zhejiang, People's Republic of China
| | - Jun Xu
- Intensive Care Unit, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003 People's Republic of China
| | - Juan Hu
- Intensive Care Unit, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003 People's Republic of China
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Solgi H, Badmasti F, Aminzadeh Z, Giske CG, Pourahmad M, Vaziri F, Havaei SA, Shahcheraghi F. Molecular characterization of intestinal carriage of carbapenem-resistant Enterobacteriaceae among inpatients at two Iranian university hospitals: first report of co-production of bla NDM-7 and bla OXA-48. Eur J Clin Microbiol Infect Dis 2017. [PMID: 28639165 DOI: 10.1007/s10096-017-3035-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Gastrointestinal colonization of carbapenem-resistant Enterobacteriaceae (CRE) could serve as a reservoir for the transmission of these pathogens in the clinical setting. The aim of this study was to investigate the intestinal carriage of CRE and to analyze risk factors for CRE carriage. Rectal swabs were collected from 95 patients at two Iranian university hospitals. CRE screening was performed using selective media (CHROMagar and MacConkey agar). Polymerase chain reaction (PCR) was used to detect carbapenemase-encoding genes. Clonal relatedness was investigated by pulsed-field gel electrophoresis (PFGE). The rate of carriage of CRE in hospitalized patients was 37.9%. Overall, 54 CRE isolates were identified, of which 47 were carbapenemase-producers. All of the 54 CRE were detected using CHROMagar compared with 52 CRE detected using MacConkey agar. Fifteen patients were colonized by multiple CRE isolates. Three significant risk factors for CRE carriage were detected: intensive care unit (ICU) hospitalization, antibiotic exposure, and mechanical ventilation. bla OXA-48 was the most frequent carbapenemase detected, followed by bla NDM-1 and bla NDM-7. Eleven carbapenemase-producing Enterobacteriaceae (CPE) isolates co-harbored bla NDM-1 and bla OXA-48. Also, six CPE isolates co-harbored bla NDM-7 and bla OXA-48. We did not detect bla KPC, bla GES, bla IMP, or bla VIM. PFGE analysis showed that Escherichia coli clones were diverse, while Klebsiella pneumoniae isolates were divided into four clusters. Cluster I was the major clone carrying bla OXA-48 and bla CTX-M-15 genes. In our study, the carriage rate of CRE was high and the emergence of CPE isolates among patients is alarming. The implementation of adequate preventive measures such as active surveillance is urgently needed to control the spread of CPE in the healthcare setting.
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Affiliation(s)
- H Solgi
- Department of Bacteriology, Microbiology Research Centre, Pasteur Institute of Iran, Tehran, Iran
| | - F Badmasti
- Department of Bacteriology, Microbiology Research Centre, Pasteur Institute of Iran, Tehran, Iran
| | - Z Aminzadeh
- Infectious Disease and Tropical Medicine Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - C G Giske
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - M Pourahmad
- Infectious Diseases Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - F Vaziri
- Department of Tuberculosis and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran
| | - S A Havaei
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - F Shahcheraghi
- Department of Bacteriology, Microbiology Research Centre, Pasteur Institute of Iran, Tehran, Iran.
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Nour I, Eldegla HE, Nasef N, Shouman B, Abdel-Hady H, Shabaan AE. Risk factors and clinical outcomes for carbapenem-resistant Gram-negative late-onset sepsis in a neonatal intensive care unit. J Hosp Infect 2017; 97:52-58. [PMID: 28583886 DOI: 10.1016/j.jhin.2017.05.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 05/30/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Carbapenem-resistant (CR), Gram-negative (GN), late-onset sepsis (LOS) is a serious threat in the neonatal intensive care unit (NICU). AIM To assess the prevalence of CR-GN-LOS in NICU patients and to identify the risk factors and outcomes associated with its acquisition. METHODS Neonates with carbapenem-susceptible (CS)-GN-LOS were compared with those with CR-GN-LOS in a two-year observational study. FINDINGS A total of 158 patients had GN-LOS; 100 infants had CS-GN-LOS and 58 infants had CR-GN-LOS. The incidence rate of CR-GN-LOS was 6.5 cases per 1000 patient-days. The most frequent bacterial strain in both groups was Klebsiella pneumoniae. The duration of total parenteral nutrition (TPN) (P=0.006) and prior carbapenem use (P=0.01) were independent risk factors for CR-GN-LOS acquisition. CR-GN-LOS was associated with higher mortality than CS-GN-LOS (P=0.04). Birth weight, small for gestational age, time to start enteral feeding, exclusive formula feeding, previous surgery, previous antifungal use, central venous device before onset, duration of central venous device, and infectious complications were identified as dependent risk factors for overall mortality. However, only male gender (P=0.04) and infectious complications (P < 0.001) were independent risk factors associated with mortality. Infectious complication rates, duration of mechanical ventilation, and length of hospital stay were significantly higher in infants with CR compared to CS-GN-LOS. CONCLUSION The duration of TPN and carbapenem use were the independent predictors for CR-GN-LOS acquisition. CR-GN-LOS is associated with higher mortality, infectious complication rates, longer mechanical ventilation, and longer hospital stay. Male gender and infectious complications were the independent risk factors for mortality in neonates with GN-LOS.
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Affiliation(s)
- I Nour
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt; Department of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt.
| | - H E Eldegla
- Department of Medical Microbiology and Immunology, Faculty of Medicine, University of Mansoura, Mansoura, Egypt; Microbiology Diagnostics and Infection Control Unit, Mansoura University Hospitals, Mansoura, Egypt
| | - N Nasef
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt; Department of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - B Shouman
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt; Department of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - H Abdel-Hady
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt; Department of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - A E Shabaan
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt; Department of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
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Forde C, Stierman B, Ramon-Pardo P, dos Santos T, Singh N. Carbapenem-resistant Klebsiella pneumoniae in Barbados: Driving change in practice at the national level. PLoS One 2017; 12:e0176779. [PMID: 28542162 PMCID: PMC5444594 DOI: 10.1371/journal.pone.0176779] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/17/2017] [Indexed: 12/02/2022] Open
Abstract
Introduction Carbapenem-resistant Klebsiella pneumoniae (CRKP) is of growing concern globally. The risk for transmission of antimicrobial resistant organisms across several continents to the Caribbean is a real one given its tourism industry. After a cluster of cases of CRKP were detected, several studies detailed in this report were initiated to better characterize the problem. Methods A hospital-wide point prevalence study and active surveillance were performed at Queen Elizabeth Hospital (QEH) in Barbados in 2013 to assess the prevalence of CRKP infection/colonization. Following this, a 1-year longitudinal study measured the prevalence of CRKP isolates in the hospital and across all healthcare facilities in the country. Results In 2013, eleven viable isolates of CRKP from cluster of cases were sent for molecular epidemiology studies. When sequenced, they were found to be the ST-258 clone. Identification of a cluster of cases of CRKP ST-258/512 clones indicated person-to-person transmission. In September 2013, the hospital-wide point prevalence study revealed 18% of patients (53/299) at the hospital were either colonized or infected with CRKP. The infection to colonization ratio was 1:7. Patients who were infected/colonized vs. non-colonized were older (64.7 vs. 48.7 years, p<0.0001), were hospitalized longer (42.5 days vs. 27 days, p = 0.0042), were more likely to have an invasive device (66% vs. 32%, p<0.0001), especially urinary catheters (55% vs. 24%, p<0.0001), and were more likely to have used antimicrobials within the prior 14 days (91% vs. 46%, p<0.0001). Specific antimicrobials, including fluoroquinolones and piperacillin-tazobactam, were significantly associated with infection/colonization. In 2014, the 12-month period prevalence of CRKP in Barbados was 49.6 per 100,000 population and of blood stream infections was 3.2 per 100,000 population. Conclusions This point prevalence study identified patients at-risk of acquisition of CRKP and allowed QEH to implement interventions aimed at decreasing the prevalence of CRKP. Organization of a National and regional Infection Prevention and Control Committee in 2014 aimed to strengthen antimicrobial resistance surveillance programs across the English-speaking Caribbean were established.
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Affiliation(s)
- Corey Forde
- Queen Elizabeth Hospital, Bridgetown, Barbados
- * E-mail: (NS); (CF)
| | - Bryan Stierman
- Children’s National Health System, Washington DC, United States of America
| | - Pilar Ramon-Pardo
- Pan American Health Organization, Washington DC, United States of America
| | - Thais dos Santos
- Pan American Health Organization, Washington DC, United States of America
| | - Nalini Singh
- Children’s National Health System, Washington DC, United States of America
- George Washington University, Washington DC, United States of America
- * E-mail: (NS); (CF)
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Cheepurupalli L, Raman T, Rathore SS, Ramakrishnan J. Bioactive Molecule from Streptomyces sp. Mitigates MDR Klebsiella pneumoniae in Zebrafish Infection Model. Front Microbiol 2017; 8:614. [PMID: 28446900 PMCID: PMC5388697 DOI: 10.3389/fmicb.2017.00614] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 03/27/2017] [Indexed: 02/02/2023] Open
Abstract
The emergence and spread of multi-drug resistant (MDR) especially carbapenem-resistant Klebsiella pneumoniae is a major emerging threat to public health, leading to excess in mortality rate as high as 50-86%. MDR K. pneumoniae manifests all broad mechanisms of drug resistance, hence development of new drugs to treat MDR K. pneumoniae infection has become a more relevant question in the scientific community. In the present study a potential Streptomyces sp. ASK2 was isolated from rhizosphere soil of medicinal plant. The multistep HPLC purification identified the active principle exhibiting antagonistic activity against MDR K. pneumoniae. The purified compound was found to be an aromatic compound with aliphatic side chain molecule having a molecular weight of 444.43 Da. FT-IR showed the presence of OH and C=O as functional groups. The bioactive compound was further evaluated for drug induced toxicity and efficacy in adult zebrafish infection model. As this is the first study on K. pneumoniae - zebrafish model, the infectious doses to manifest sub-clinical and clinical infection were optimized. Furthermore, the virulence of K. pneumoniae in planktonic and biofilm state was studied in zebrafish. The MTT assay of ex vivo culture of zebrafish liver reveals non-toxic nature of the proposed ASK2 compound at an effective dose. Moreover, significant increase in survival rate of infected zebrafish suggests that ASK2 compound from a new strain of Streptomyces sp. was potent in mitigating MDR K. pneumoniae infection.
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Affiliation(s)
- Lalitha Cheepurupalli
- Actinomycetes Bioprospecting Lab, Centre for Research in Infectious Diseases, School of Chemical and Biotechnology, SASTRA UniversityTirumalaisamudram, India
| | - Thiagarajan Raman
- Laboratory for Inflammation Research, Centre for Research in Infectious Diseases, School of Chemical and Biotechnology, SASTRA UniversityTirumalaisamudram, India
| | - Sudarshan S. Rathore
- Actinomycetes Bioprospecting Lab, Centre for Research in Infectious Diseases, School of Chemical and Biotechnology, SASTRA UniversityTirumalaisamudram, India
| | - Jayapradha Ramakrishnan
- Actinomycetes Bioprospecting Lab, Centre for Research in Infectious Diseases, School of Chemical and Biotechnology, SASTRA UniversityTirumalaisamudram, India
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Jin Y, Song X, Liu Y, Wang Y, Zhang B, Fan H, Shao C. Characteristics of carbapenemase-producing Klebsiella pneumoniae as a cause of neonatal infection in Shandong, China. Exp Ther Med 2017; 13:1117-1126. [PMID: 28450951 DOI: 10.3892/etm.2017.4070] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/01/2016] [Indexed: 12/12/2022] Open
Abstract
The goal of the present study was to examine the characteristics of carbapenem-resistant Klebsiella pneumoniae as a cause of neonatal infection. A total of 37 carbapenem-resistant Klebsiella pneumoniae-positive newborns hospitalized in Shandong Provincial Hospital, China between April 2011 and October 2013 were examined. Antibiotic susceptibility testing was performed using the agar dilution method and the Etest. Resistance genes were assessed by polymerase chain reaction (PCR) and sequencing. Pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST) were used to determine the genotypes and homology of these isolates. Plasmids were analyzed by PFGE and conjugation experiments. The outer membrane proteins were examined by PCR and SDS-PAGE. All of the isolates were revealed to be resistant to the third and fourth generation cephalosporins and piperacillin-tazobactam. Tigecycline, colistin, levofloxacin and amikacin were successful against all of the isolates. The antibiotic resistance rates of aztreonam, gentamicin, trimethoprim-sulfamethoxazole and fosfomycin were 13.51, 48.64, 78.38 and 86.49%, respectively. Of the 37 cases, 25 isolates (67.57%) were blaNDM-1 positive, 13 isolates (35.14%) were blaIMP-4 positive and 1 isolate (2.70%) was blaIMP-8 positive. Two isolates carried both blaNDM-1 and blaIMP-4. The isolate carrying 2-4 plasmids and blaNDM-1 and blaIMP-4 was transferable between strains. SDS-PAGE data indicated that outer membrane proteins remained present. PFGE revealed 7 distinct clusters, and MLST reported the presence of ST20, ST17, ST54, ST705 and ST290 sequences, which indicated that there was clone and plasmid spread between newborns. The main resistance mechanism of carbapenem-resistant Klebsiella pneumoniae was that the isolates expressed the carbapenemase resistance of blaNDM-1 and blaIMP-4 genes. The current study indicates that early detection of these genes may be helpful in infection prevention and control.
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Affiliation(s)
- Yan Jin
- Department of Microbiology, Clinical Laboratory, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Xiaofei Song
- Department of Immunology, Clinical Laboratory, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Yigang Liu
- Department of Microbiology, Clinical Laboratory, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Yong Wang
- Department of Microbiology, Clinical Laboratory, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Bingchang Zhang
- Department of Microbiology, Clinical Laboratory, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Hui Fan
- Department of Microbiology, Clinical Laboratory, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Chunhong Shao
- Department of Microbiology, Clinical Laboratory, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
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Meng X, Liu S, Duan J, Huang X, Zhou P, Xiong X, Gong R, Zhang Y, Liu Y, Fu C, Li C, Wu A. Risk factors and medical costs for healthcare-associated carbapenem-resistant Escherichia coli infection among hospitalized patients in a Chinese teaching hospital. BMC Infect Dis 2017; 17:82. [PMID: 28095785 PMCID: PMC5242049 DOI: 10.1186/s12879-016-2176-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 12/27/2016] [Indexed: 01/03/2023] Open
Abstract
Background The emergence and spread of Carbapenem-resistant Escherichia coli (CREC) is becoming a serious problem in Chinese hospitals, however, the data on this is scarce. Therefore, we investigate the risk factors for healthcare-associated CREC infection and study the incidence, antibiotic resistance and medical costs of CREC infections in our hospital. Methods We conducted a retrospective, matched case–control–control, parallel study in a tertiary teaching hospital. Patients admitted between January 2012 and December 2015 were included in this study. For patients with healthcare-associated CREC infection, two matched subject groups were created; one group with healthcare-associated CSEC infection and the other group without infection. Results Multivariate conditional logistic regression analysis demonstrated that prior hospital stay (<6 months) (OR:3.96; 95%CI:1.26–12.42), tracheostomy (OR:2.24; 95%CI: 1.14–4.38), central venous catheter insertion (OR: 8.15; 95%CI: 2.31–28.72), carbapenem exposure (OR: 12.02; 95%CI: 1.52–95.4), urinary system disease (OR: 16.69; 95%CI: 3.01–89.76), low hemoglobin (OR: 2.83; 95%CI: 1.46–5.50), and high blood glucose are associated (OR: 7.01; 95%CI: 1.89–26.02) with CREC infection. Total costs (p = 0.00), medical examination costs (p = 0.00), medical test costs (p = 0.00), total drug costs (p = 0.00) and ant-infective drug costs (p = 0.00) for the CREC group were significantly higher than those for the no infection group. Medical examination costs (p = 0.03), total drug costs (p = 0.03), and anti-infective drug costs (p = 0.01) for the CREC group were significantly higher than for the CSEC group. Mortality in CREC group was significantly higher than the CSEC group (p = 0.01) and no infection group (p = 0.01). Conclusion Many factors were discovered for acquisition of healthcare-associated CREC infection. CREC isolates were resistant to most antibiotics, and had some association with high financial burden and increased mortality.
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Affiliation(s)
- Xiujuan Meng
- Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China
| | - Sidi Liu
- Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China
| | - Juping Duan
- Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China
| | - Xun Huang
- Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China
| | - Pengcheng Zhou
- Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China
| | - Xinrui Xiong
- Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China
| | - Ruie Gong
- Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China
| | - Ying Zhang
- Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China
| | - Yao Liu
- Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China
| | - Chenchao Fu
- Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China
| | - Chunhui Li
- Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China.
| | - Anhua Wu
- Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China.
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Akgul F, Bozkurt I, Sunbul M, Esen S, Leblebicioglu H. Risk factors and mortality in the Carbapenem-resistant Klebsiella pneumoniae infection: case control study. Pathog Glob Health 2016; 110:321-325. [PMID: 27903130 DOI: 10.1080/20477724.2016.1254976] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Carbapenem-resistant Klebsiella pneumoniae (CRKP) has been known as a nosocomial pathogen, both for the last 10 years in Turkey and for 20 years worldwide. Due to limited treatment options and high mortality rates, despite improvements in the field of medicine at the present time, CRKP is still a big threat for public health. This study was carried out between the dates of January 2010 and September 2014. Patients ≥18 who were hospitalized for at least 72 h and who also had CRKP growth were included in the study as a case group. In the same period patients, who were hospitalized in the same ward and did not have CRKP growth were selected as the control group. It was determined that no glycopeptides and steroids use nor tracheostomy as protective factors would be employed in terms of non-development of CRKP. Mechanical ventilation, tracheostomy, urinary catheter presence, central venous catheterization, nasogastric tube placement, advanced age, acute renal insufficiency, total parenteral nutrition, carbapenem, glycopeptide, and piperacillin tazobactam were all detected as risk factors in terms of CRKP infection development. As a result, rational usage of antibiotics for preventing infections developing with CRKP should be targeted.
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Affiliation(s)
- Fethiye Akgul
- a Department of Clinical Microbiology and Infectious Diseases , School of Medicine, Ondokuz Mayis University , Samsun , Turkey
| | - Ilkay Bozkurt
- a Department of Clinical Microbiology and Infectious Diseases , School of Medicine, Ondokuz Mayis University , Samsun , Turkey
| | - Mustafa Sunbul
- a Department of Clinical Microbiology and Infectious Diseases , School of Medicine, Ondokuz Mayis University , Samsun , Turkey
| | - Saban Esen
- a Department of Clinical Microbiology and Infectious Diseases , School of Medicine, Ondokuz Mayis University , Samsun , Turkey
| | - Hakan Leblebicioglu
- a Department of Clinical Microbiology and Infectious Diseases , School of Medicine, Ondokuz Mayis University , Samsun , Turkey
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Durdu B, Hakyemez IN, Bolukcu S, Okay G, Gultepe B, Aslan T. Mortality markers in nosocomial Klebsiella pneumoniae bloodstream infection. SPRINGERPLUS 2016; 5:1892. [PMID: 27843749 PMCID: PMC5084144 DOI: 10.1186/s40064-016-3580-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 10/19/2016] [Indexed: 11/10/2022]
Abstract
PURPOSE Klebsiella pneumoniae is the most common endogen agent for nosocomial infections. In this study, mortality markers were investigated in patients with nosocomial K. pneumoniae blood stream infection (NKp BSI). METHODS The characteristics of patients >16 years who had NKp BSI diagnosis by daily active surveillance between January 2012 and January 2016 were retrospectively evaluated. Patients who died until 28th day of the clinical follow up and those who survived until this time were statistically compared in terms of various risk factors. RESULTS One hundred ninety patients were included into the study. Mortality rate was 47.9%, carbapenem resistance was 43.2%. Statistical analysis have shown that in presence of post-NKp BSI sepsis, septic shock, following in intensive care unit (ICU), meropenem resistance, kidney failure, NKp BSI secondary to pneumonia, use of invasive instruments such as central venous catheter (CVC), urinary catheter (UC) and mechanical ventilator (MV), colostomy, transfusion and hemodialysis mortality was significantly higher. In patients admitted into the hospital for neurological disorders, pancreaticobiliary tract (PBT) diseases and patients who have undergone endoscopic retrograde cholangiopancreatography (ERCP) and patients in whom NKp BSI secondary to PBT infection mortality rate was lower. CONCLUSIONS Sepsis, septic shock, clinical conditions requiring ICU treatment and meropenem resistance increase mortality rates in NKp BSI significantly. Mortality was higher also in patients with NKp BSI secondary to pneumonia, in kidney failure and when invasive instruments were used. On the other hand, in patients who were admitted to the hospital for neurological disorders and PBT diseases mortality rate was lower.
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Affiliation(s)
- Bulent Durdu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Boulevard, Fatih, 34093 Istanbul, Turkey
| | - Ismail Necati Hakyemez
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Boulevard, Fatih, 34093 Istanbul, Turkey
| | - Sibel Bolukcu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Boulevard, Fatih, 34093 Istanbul, Turkey
| | - Gulay Okay
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Boulevard, Fatih, 34093 Istanbul, Turkey
| | - Bilge Gultepe
- Department of Microbiology and Clinical Microbiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Turan Aslan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Boulevard, Fatih, 34093 Istanbul, Turkey
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Molecular epidemiology of carbapenem resistant gram-negative bacilli from infected pediatric population in tertiary - care hospitals in Medellín, Colombia: an increasing problem. BMC Infect Dis 2016; 16:463. [PMID: 27585707 PMCID: PMC5009693 DOI: 10.1186/s12879-016-1805-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 08/24/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Gram-negative bacilli are a cause of serious infections in the pediatric population. Carbapenem are the treatment of choice for infections caused by multidrug-resistant Gram-negative bacilli, but the emergence of carbapenem resistance has substantially reduced access to effective antimicrobial regimens. Children are a population vulnerable to bacterial infections and the emergence of resistance can worsen prognosis. The aim of this study is to describe the clinical and molecular characteristics of infections caused by carbapenem-resistant Gram-negative bacilli in pediatric patients from five tertiary-care hospitals in Medellín, Colombia. METHODS A cross-sectional study was conducted in five tertiary-care hospitals from June 2012 to June 2014. All pediatric patients infected by carbapenem-resistant Gram-negative bacilli were included. Clinical information for each patient was obtained from medical records. Molecular analyses included PCR for detection of bla VIM, bla IMP bla NDM, bla OXA-48 and bla KPC genes and PFGE and MLST for molecular typing. RESULTS A total of 59 patients were enrolled, most of them less than 1 year old (40.7 % n = 24), with a previous history of antibiotic use (94.9 %; n = 56) and healthcare-associated infections - predominately urinary tract infections (31.0 %; n = 18). Klebsiella pneumoniae was the most frequent bacteria (47.4 %), followed by Enterobacter cloacae (40.7 %) and Pseudomonas aeruginosa (11.9 %). For K. pneumoniae, KPC was the predominant resistance mechanism (85.7 %; n = 24) and ST14 was the most common clone (39.3 % n = 11), which included strains closely related by PFGE. In contrast, E. cloacae and P. aeruginosa were prevailing non-carbapenemase-producing isolates (only KPC and VIM were detected in 1 and 3 isolates, respectively) and high genetic diversity according to PFGE and MLST was found in the majority of the cases. CONCLUSIONS In recent years, increasing carbapenem-resistant bacilli in children has become in a matter of great concern. It is important to conduct systemic surveillance and take measures to prevent dissemination of multidrug-resistant bacteria.
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