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Zhou H, Buetti N, Pérez-Galera S, Bravo-Ferrer J, Gutiérrez-Gutiérrez B, Paniagua-García M, Feifel J, Sauser J, Kostyanev T, Canton R, Tan LK, Basoulis D, Pintado V, Roilides E, Dragovac G, Torre-Cisneros J, Mediç D, Akova M, Goossens H, Bonten M, Harbarth S, Rodriguez-Baño J, De Kraker MEA. Risk factors for bloodstream infections due to carbapenem-resistant Enterobacterales: a nested case-control-control study. J Antimicrob Chemother 2024:dkae157. [PMID: 38988305 DOI: 10.1093/jac/dkae157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/02/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Carbapenem-resistant Enterobacterales (CRE) bloodstream infections (BSIs) are a major threat to patients. To date, data on risk factors have been limited, with low internal and external validity. In this multicentre study, risk factors for CRE BSI were determined by comparison with two control groups: patients with carbapenem-susceptible Enterobacterales (CSE) BSI, and patients without Enterobacterales infection (uninfected patients). METHODS A multicentre, case-control-control study was nested in a European prospective cohort study on CRE (EURECA). CRE BSI:CSE BSI matching was 1:1, CRE BSI:Uninfected patients matching was 1:3, based on hospital, ward and length of stay. Conditional logistic regression was applied. RESULTS From March 2016 to November 2018, 73 CRE BSIs, 73 CSE BSIs and 219 uninfected patients were included from 18 European hospitals. For CRE versus CSE BSI, previous CRE colonization/infection [incidence rate ratio (IRR) 7.32; 95% CI 1.65-32.38) increased the risk. For CRE versus uninfected controls, independent risk factors included: older age (IRR 1.03; 95% CI 1.01-1.06), patient referral (long-term care facility: IRR 7.19; 95% CI 1.51-34.24; acute care hospital: IRR 5.26; 95% CI 1.61-17.11), previous colonization/infection with other MDR organisms (MDROs) (IRR 9.71; 95% CI 2.33-40.56), haemodialysis (IRR 8.59; 95% CI 1.82-40.53), invasive procedures (IRR 5.66; 95% CI 2.11-15.16), and β-lactam/β-lactamase inhibitor combinations (IRR 3.92; 95% CI 1.68-9.13) or third/fourth generation cephalosporin (IRR 2.75; 95% CI 1.06-7.11) exposure within 3 months before enrolment. CONCLUSIONS Evidence of previous CRE colonization/infection was a major risk factor for carbapenem resistance among Enterobacterales BSI. Compared with uninfected patients, evidence of previous MDRO colonization/infection and healthcare exposure were important risk factors for CRE BSI. Targeted screening, infection prevention and antimicrobial stewardship should focus on these high-risk patients.
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Affiliation(s)
- Hongyu Zhou
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Department of Hospital Infection Control, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Niccolò Buetti
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Infection Antimicrobials Modeling Evolution (IAME) U 1137, INSERM, Université Paris-Cité, Paris, France
| | - Salvador Pérez-Galera
- Unidad Clínica de Medicina Interna, Hospital Universitario Virgen Macarena, Seville, Spain
- Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Departamento de Medicina, Universidad de Sevilla, Seville, Spain
| | - Jose Bravo-Ferrer
- Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Departamento de Medicina, Universidad de Sevilla, Seville, Spain
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Belén Gutiérrez-Gutiérrez
- Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Departamento de Medicina, Universidad de Sevilla, Seville, Spain
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - María Paniagua-García
- Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Departamento de Medicina, Universidad de Sevilla, Seville, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, Seville, Spain
| | - Jan Feifel
- Institute of Statistics, Ulm University, Ulm, Germany
| | - Julien Sauser
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Tomi Kostyanev
- Laboratory of Medical Microbiology, University of Antwerp, Antwerp, Belgium
- National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | - Rafael Canton
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Lionel K Tan
- Research and Development, GlaxoSmithKline, London, UK
| | - Dimitris Basoulis
- First Department of Internal Medicine, Laiko General Hospital, Athens, Greece
| | - Vicente Pintado
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Emmanuel Roilides
- Faculty of Health Sciences, Hippokration General Hospital of Thessaloniki, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Gorana Dragovac
- Faculty of Medicine and Institute of Public Health of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | - Julian Torre-Cisneros
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Departamento de Ciencias Médicas y Quirúrgicas, Servicio de Enfermedades Infecciosas Hospital Universitario Reina Sofía/Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Universidad de Córdoba, Córdoba, Spain
| | - Deana Mediç
- Faculty of Medicine and Institute of Public Health of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | - Murat Akova
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey
| | - Herman Goossens
- Laboratory of Medical Microbiology, University of Antwerp, Antwerp, Belgium
| | - Marc Bonten
- Julius Center for Health Sciences and Primary Care and University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Jesus Rodriguez-Baño
- Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Departamento de Medicina, Universidad de Sevilla, Seville, Spain
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Marlieke E A De Kraker
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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廖 全, 袁 余, 张 为, 邓 劲, 康 梅. [Carbapenemase Genes, Virulence Genes, and Molecular Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae Derived From Bloodstream Infections]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2024; 55:391-396. [PMID: 38645859 PMCID: PMC11026891 DOI: 10.12182/20240360202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Indexed: 04/23/2024]
Abstract
Objective To investigate the clinical characteristics and molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae (CRKP) isolated from patients with bloodstream infections in a large tertiary-care general hospital in Southwest China. Methods A total of 131 strains of non-repeating CRKP were collected from the blood cultures of patients who had bloodstream infections in 2015-2019. The strains were identified by VITEK-2, a fully automated microbial analyzer, and matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry. The minimum inhibitory concentration (MIC) was determined by microbroth dilution method. The common carbapenemase resistant genes and virulence factors were identified by PCR. Homology analysis was performed by multilocus sequencing typing. Whole genome sequencing was performed to analyze the genomic characteristics of CRKP without carbapenemase. Results The 131 strains of CRKP showed resistance to common antibiotics, except for polymyxin B (1.6% resistance rate) and tigacycline (8.0% resistance rate). A total of 105 (80.2%) CRKP strains carried the Klebsiella pneumoniae carbapenemase (KPC) resistance gene, 15 (11.4%) strains carried the New Delhi Metallo-β-lactamase (NDM) gene, and 4 (3.1%) isolates carried both KPC and NDM genes. Sequence typing (ST) 11 (74.0%) was the dominant sequence type. High detection rates for mrkD (96.2%), fimH (98.5%), entB (100%), and other virulence genes were reported. One hypervirulent CRKP strain was detected. The seven strains of CRKP that did not produce carbapenemase were shown to carry ESBL or AmpC genes and had anomalies in membrane porins OMPK35 and OMPK36, according to whole genome sequencing. Conclusion In a large-scale tertiary-care general hospital, CRKP mainly carries the KPC gene, has a high drug resistance rate to a variety of antibiotics, and possesses multiple virulence genes. Attention should be paid to CRKP strains with high virulence.
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Affiliation(s)
- 全凤 廖
- 四川大学华西医院 实验医学科 (成都 610041)Department of Experimental Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 余 袁
- 四川大学华西医院 实验医学科 (成都 610041)Department of Experimental Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 为利 张
- 四川大学华西医院 实验医学科 (成都 610041)Department of Experimental Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 劲 邓
- 四川大学华西医院 实验医学科 (成都 610041)Department of Experimental Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 梅 康
- 四川大学华西医院 实验医学科 (成都 610041)Department of Experimental Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
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Zhang YQ, Wu WQ, Xu J, Tang ZX, Li SJ, Li L, Wu HQ, Ma X, Liu JS, Wu DP, Wu XJ. A clinical predictive model for pre-transplantation Klebsiella pneumoniae colonization and relevance for clinical outcomes in patients receiving allogeneic hematopoietic stem cell transplantation. Microbiol Spectr 2024; 12:e0203923. [PMID: 38189331 PMCID: PMC10846164 DOI: 10.1128/spectrum.02039-23] [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: 05/17/2023] [Accepted: 12/02/2023] [Indexed: 01/09/2024] Open
Abstract
The purpose of this study is to establish a clinical prediction model to discriminate patients at high risk of Klebsiella pneumoniae (KP) colonization before allogeneic hematopoietic stem cell transplantation (allo-HSCT) and evaluate the impact of KP colonization on clinical outcomes after allo-HSCT. We retrospectively collected data from 2,157 consecutive patients receiving allo-HSCT between January 2018 and March 2022. KP colonization was defined as a positive test for KP from a pharyngeal or anal swab before allo-HSCT. Logistic regression was used to build a clinical prediction model. Cox regression analyses were performed to explore the effect of KP colonization on clinical outcomes. Among all the inpatients, 166 patients had KP colonization and 581 with no positive pathogenic finding before transplantation. Seven candidate predictors were entered into the final prediction model. The prediction model had an area under the curve of 0.775 (95% CI 0.723-0.828) in the derivation cohort and 0.846 (95% CI: 0.790-0.902) in the validation cohort. Statistically significantly different incidence rates were observed among patient groups with clinically predicted low, medium, and high risk for KP infection (P < 0.001). The presence of KP colonization delayed platelet engraftment (P < 0.001) and patients with KP colonization were more likely to develop KP bloodstream infections within 100 days after allo-HSCT (P < 0.0001). Patients with KP colonization had higher non-relapse mortality (P = 0.032), worse progression-free survival (P = 0.0027), and worse overall survival within 100 days after allo-HSCT (P = 0.013). Our findings suggest that increased awareness of risks associated with pre-transplantation bacterial colonization is warranted.IMPORTANCESeveral studies have identified that Klebsiella pneumoniae (KP) is among the most common and deadly pathogens for patients in hospital intensive care units and those receiving transplantation. However, there are currently no studies that evaluate the impact of KP colonization to patients undergoing allogeneic hematopoietic stem cell transplantation. Our results confirm that pre-existing KP colonization is relatively common in a hematology transplant ward setting and negatively affects post-transplantation prognosis. Our clinical prediction model for KP colonization can support early intervention in patients at high risk to avoid subsequent bloodstream infections and improve survival outcomes. Altogether, our data suggest that increased awareness of risks associated with pre-transplantation bacterial colonization is warranted. Future studies are needed to confirm these findings and to test early intervention strategies for patients at risk of complications from KP infection.
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Affiliation(s)
- Yu-Qi Zhang
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, Jiangsu, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, China
| | - Wen-Qi Wu
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, Jiangsu, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, China
| | - Jie Xu
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, Jiangsu, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, China
| | - Zai-Xiang Tang
- Department of Epidemiology and Statistics, School of Public Health, Faculty of Medicine, Soochow University, Suzhou, Jiangsu, China
| | - Shi-Jia Li
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, Jiangsu, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, China
| | - Ling Li
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, Jiangsu, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, China
| | - He-Qing Wu
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, Jiangsu, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, China
| | - Xiao Ma
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, Jiangsu, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, China
| | - Ji-Sheng Liu
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - De-Pei Wu
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, Jiangsu, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, China
| | - Xiao-Jin Wu
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, Jiangsu, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, China
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Tofarides AG, Dimitriou P, Nikolopoulos GK, Rogkas D, Flourou C, Khattab E, Kasapi D, Azina C, Christaki E. Factors Associated with Extended-Spectrum β-Lactamases and Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infections: A Five-Year Retrospective Study. Pathogens 2023; 12:1277. [PMID: 38003742 PMCID: PMC10675166 DOI: 10.3390/pathogens12111277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/19/2023] [Accepted: 10/21/2023] [Indexed: 11/26/2023] Open
Abstract
Klebsiella pneumoniae is one of the leading causes of nosocomial infections. It has been estimated that nosocomial infection by Klebsiella pneumoniae comprises 3-8% of all nosocomial infections. Klebsiella pneumoniae bloodstream infections (BSIs) occur worldwide with varying mortality. Resistant strains, like those producing extended-spectrum beta-lactamases (ESBL) and carbapenemases, are becoming increasingly common, especially in hospital settings, posing therapeutic challenges. In this article, we aimed to study the epidemiology and risk factors of BSIs due to resistant Klebsiella pneumoniae strains in the period 1 January 2014-31 December 2018 at the Nicosia General Hospital, the largest tertiary hospital in Cyprus. Data on demographics, co-morbidities, prior hospitalization, prior intensive care unit (ICU) admission, previous antimicrobial use, nosocomial acquisition of the infection, the presence of a prosthetic device or surgery, and the primary site of infection were retrospectively recorded. Associations between the detection of ESBL Klebsiella pneumoniae BSIs and factors/covariates were examined using logistic regression. This study involved 175 patients with BSI caused by Klebsiella pneumoniae. Of these, 61 BSIs were caused by ESBL strains, 101 by non-ESBL, and 13 by carbapenem-resistant (CR) strains. In univariable analyses, age, sex, heart disease, antimicrobial use during current admission, previous hospitalization (ward or ICU), and primary BSI were associated with the presence of an ESBL strain. Antibiotic use during current admission and heart disease remained statistically significantly associated with ESBL Klebsiella pneumoniae BSI in multivariable models. Antibiotic use during current admission, respiratory infection, and a recent history of surgery were more prevalent among CR Klebsiella pneumoniae BSI patients than among non-CR Klebsiella pneumoniae BSI patients. Our study showed that recent antimicrobial use and heart disease were associated with BSI due to ESBL-producing Klebsiella pneumoniae. This finding could inform clinical practice in hospital settings.
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Affiliation(s)
- Andreas G. Tofarides
- Department of Internal Medicine, Nicosia General Hospital, 2029 Nicosia, Cyprus; (P.D.); (C.F.); (E.K.); (D.K.); (C.A.)
- 1st Division of Internal Medicine & Infectious Diseases Unit, University Hospital of Ioannina, Faculty of Medicine, University of Ioannina, 45500 Ioannina, Greece;
| | - Panagiotis Dimitriou
- Department of Internal Medicine, Nicosia General Hospital, 2029 Nicosia, Cyprus; (P.D.); (C.F.); (E.K.); (D.K.); (C.A.)
| | | | - Dimitrios Rogkas
- 1st Division of Internal Medicine & Infectious Diseases Unit, University Hospital of Ioannina, Faculty of Medicine, University of Ioannina, 45500 Ioannina, Greece;
| | - Christina Flourou
- Department of Internal Medicine, Nicosia General Hospital, 2029 Nicosia, Cyprus; (P.D.); (C.F.); (E.K.); (D.K.); (C.A.)
| | - Elina Khattab
- Department of Internal Medicine, Nicosia General Hospital, 2029 Nicosia, Cyprus; (P.D.); (C.F.); (E.K.); (D.K.); (C.A.)
| | - Diamanto Kasapi
- Department of Internal Medicine, Nicosia General Hospital, 2029 Nicosia, Cyprus; (P.D.); (C.F.); (E.K.); (D.K.); (C.A.)
| | - Chara Azina
- Department of Internal Medicine, Nicosia General Hospital, 2029 Nicosia, Cyprus; (P.D.); (C.F.); (E.K.); (D.K.); (C.A.)
| | - Eirini Christaki
- 1st Division of Internal Medicine & Infectious Diseases Unit, University Hospital of Ioannina, Faculty of Medicine, University of Ioannina, 45500 Ioannina, Greece;
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Sun X, Zou X, Zhou B, Yin T, Wang P. Comparison of bloodstream and non-bloodstream infections caused by carbapenem-resistant Klebsiella pneumoniae in the intensive care unit: a 9-year respective study. Front Med (Lausanne) 2023; 10:1230721. [PMID: 37795412 PMCID: PMC10547144 DOI: 10.3389/fmed.2023.1230721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/31/2023] [Indexed: 10/06/2023] Open
Abstract
Background Bloodstream infections (BSIs) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) have received much attention. However, few studies have identified risk factors for CRKP BSIs in comparison to CRKP non-bloodstream infections (non-BSIs). This study aimed to compare the epidemiology, risk factors, and outcomes of CRKP BSIs and CRKP non-BSIs. Methods We conducted a retrospective study of patients infected with CRKP in the ICU from January 2012 to December 2020. Clinical characteristics and outcomes were compared between CRKP BSIs and CRKP non-BSIs. Predictors associated with 28-day all-cause mortality in CRKP-infected patients were also evaluated. Results 326 patients infected with CRKP were enrolled, including 96 patients with CRKP BSIs and 230 with CRKP non-BSIs. The rates of CRKP BSIs in CRKP infections were generally raised from 2012 (12.50%) to 2020 (45.76%). Multivariate logistic analysis indicated that the use of carbapenems within the prior 90 days was an independent risk factor for CRKP BSIs (p = 0.019). Compared to CRKP non-BSIs, CRKP isolates in the CRKP BSI group were found to be non-susceptible to more tested carbapenems (p = 0.001). Moreover, the CRKP BSI group exhibited a higher mortality rate (p = 0.036). The non-susceptibility of CRKP isolates to more tested carbapenems (p = 0.025), a high SOFA score (p = 0.000), and the use of antifungal drugs within the prior 90 days (p = 0.018) were significant factors for 28-day all-cause mortality in CRKP-infected patients. Conclusion The proportion of CRKP BSI increased progressively in CRKP-infected patients over 9 years. The use of carbapenems within the prior 90 days was an independent risk factor for the development of CRKP BSIs. The non-susceptibility of CRKP isolates to more tested carbapenems and a higher mortality rate were found in the CRKP BSI group.
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Affiliation(s)
- Xiangyuan Sun
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha Hunan, China
- Department of Pharmacy, Lixian People’s Hospital, Lixian, Hunan, China
| | - Xiaocui Zou
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha Hunan, China
| | - Boting Zhou
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Tao Yin
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ping Wang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Ndlovu T, Kgosietsile L, Motshwarakgole P, Ndlovu SI. Evaluation of Potential Factors Influencing the Dissemination of Multidrug-Resistant Klebsiella pneumoniae and Alternative Treatment Strategies. Trop Med Infect Dis 2023; 8:381. [PMID: 37624319 PMCID: PMC10459473 DOI: 10.3390/tropicalmed8080381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 08/26/2023] Open
Abstract
The increasing reports of multidrug-resistant Klebsiella pneumoniae have emerged as a public health concern, raising questions about the potential routes for the evolution and dissemination of the pathogenic K. pneumoniae into environmental reservoirs. Potential drivers of the increased incidence of antimicrobial-resistant environmental K. pneumoniae include the eminent global climatic variations as a direct or indirect effect of human activities. The ability of microorganisms to adapt and grow at an exponential rate facilitates the distribution of environmental strains with acquired resistant mutations into water systems, vegetation, and soil which are major intersection points with animals and humans. The bacterial pathogen, K. pneumoniae, is one of the critical-priority pathogens listed by the World Health Organization, mostly associated with hospital-acquired infections. However, the increasing prevalence of pathogenic environmental strains with similar characteristics to clinical-antibiotic-resistant K. pneumoniae isolates is concerning. Considering the eminent impact of global climatic variations in the spread and dissemination of multidrug-resistant bacteria, in this review, we closely assess factors influencing the dissemination of this pathogen resulting in increased interaction with the environment, human beings, and animals. We also look at the recent developments in rapid detection techniques as part of the response measures to improve surveillance and preparedness for potential outbreaks. Furthermore, we discuss alternative treatment strategies that include secondary metabolites such as biosurfactants and plant extracts with high antimicrobial properties.
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Affiliation(s)
- Thando Ndlovu
- Department of Biological Sciences, Faculty of Science, University of Botswana, Private Bag UB, Gaborone 0022, Botswana; (L.K.); (P.M.)
| | - Lebang Kgosietsile
- Department of Biological Sciences, Faculty of Science, University of Botswana, Private Bag UB, Gaborone 0022, Botswana; (L.K.); (P.M.)
| | - Pako Motshwarakgole
- Department of Biological Sciences, Faculty of Science, University of Botswana, Private Bag UB, Gaborone 0022, Botswana; (L.K.); (P.M.)
| | - Sizwe I. Ndlovu
- Department of Biotechnology and Food Technology, Doornfontein Campus, University of Johannesburg, Johannesburg 2028, South Africa;
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Xu J, Yuan Y, Wang B, Zhang Q, Wang J, Wang S, Li Y, Yan W. Microbiological Analysis and Mortality Risk Factors in Patients with Polymicrobial Bloodstream Infections. Infect Drug Resist 2023; 16:3917-3927. [PMID: 37361937 PMCID: PMC10290474 DOI: 10.2147/idr.s412669] [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: 03/16/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023] Open
Abstract
Purpose To study the etiological characteristics and risk factors affecting the prognosis of patients with polymicrobial bloodstream infections. Patients and Methods Overall, 141 patients with polymicrobial bloodstream infections in Henan Provincial People's Hospital during 2021 were included. Laboratory test indexes, department of admission, sex, age, intensive care unit (ICU) admission, surgical history, and central venous catheter placement were collected. Patients were divided into surviving and deceased groups based on outcomes at discharge. Mortality risk factors were identified by univariate and multivariable analyses. Results Seventy-two of 141 patients survived. Patients were mainly from the ICU and the Departments of Hepatobiliary Surgery and Hematology. Overall, 312 microbial strains were detected: 119 gram-positive, 152 gram-negative, and 13 anaerobic bacteria and 28 fungi. Among the gram-positive bacteria, coagulase-negative staphylococci were most frequent (44/119, 37%), followed by enterococci (35/119, 29.4%). Among coagulase-negative staphylococci, methicillin-resistant coagulase-negative staphylococci incidence was 75% (33/44). Among gram-negative bacteria, Klebsiella pneumoniae was most common (45/152, 29.6%), followed by Escherichia coli (25/152, 16.4%) and Pseudomonas aeruginosa (13/152, 8.6%). Among K. pneumoniae, the incidence of carbapenem-resistant (CR) K. pneumoniae was 45.7% (21/45). On univariate analysis, mortality risk factors included increased white blood cells and C-reactive protein, decreased total protein and albumin, CR strains, ICU admission, central venous catheter, multiple organ failure, sepsis, shock, pulmonary diseases, respiratory failure, central nervous system diseases, cardiovascular diseases, hypoproteinemia, and electrolyte disturbances (P < 0.05). Multivariable analysis showed that ICU admission, shock, electrolyte disorders, and central nervous system diseases were independent mortality risk factors. The survival curve shows that the survival rate of patients with polymicrobial CR bloodstream infections was lower than that of patients with polymicrobial non-CR bloodstream infections (P=0.029). Conclusion Patients with polymicrobial bloodstream infections are typically critically ill and harbor multidrug-resistant bacteria. Thus, to minimize mortality rate in critically ill patients, changes in infectious flora should be monitored, antibiotics selected reasonably, and invasive procedures reduced.
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Affiliation(s)
- Junhong Xu
- Department of Clinical Laboratory, 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
| | - Youhua Yuan
- Department of Clinical Laboratory, 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
| | - Baoya Wang
- Department of Clinical Laboratory, 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
| | - Qi Zhang
- Department of Clinical Laboratory, 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
| | - Jing Wang
- Xinyang Third People’s Hospital, Xinyang, Henan, 464000, People’s Republic of China
| | - Shanmei Wang
- Department of Clinical Laboratory, 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 Laboratory, 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 Laboratory, 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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8
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Zhu Q, Xu J, Chen X, Ren Y, Zhao L. Risk factors and molecular epidemiology of bloodstream infections due to carbapenem-resistant Klebsiella pneumoniae. Diagn Microbiol Infect Dis 2023; 106:115955. [PMID: 37167651 DOI: 10.1016/j.diagmicrobio.2023.115955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/24/2023] [Accepted: 04/11/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE Carbapenem-resistant Klebsiella pneumoniae (CRKP) is emerging as a worldwide public health concern; however, molecular epidemiological surveillance of clinical CRKP bloodstream infection (BSI) in China is limited. We conducted a retrospective observational study to assess risk factors and the molecular epidemiology of CRKP BSI. METHODS We reviewed the medical records of enrolled patients to assess risk factors of CRKP BSI. Characteristics of CRKP isolates were analyzed by whole genome sequencing and Kleborate. Evolutionary diversification in CRKP isolates was described through Single Nucleotide Polymorphisms analysis and phylogenetic tree construction. RESULTS We found that prior ICU hospitalization and use of carbapenems were independent risk factors for CRKP BSI. The main CRKP sequence type (ST) and capsular serotype were ST11 and KL64, and KPC-2 was the most prevalent enzyme type of carbapenemase-carrying Klebsiella pneumoniae. The most prevalent aerobactin and yersiniabactin of ST11-CRKP were iuc-1 and ybt9 ICEKp3, as for KL64-CRKP. Phylogenomic analysis showed that the antibacterial resistance genes on plasmids were highly consistent, but the genetic background of the chromosomes was still different. CONCLUSIONS Our findings are important for hospitals, allowing them to limit dissemination of CRKP and optimize antibiotic administration.
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Affiliation(s)
- Qiongfang Zhu
- Center of Clinical Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jie Xu
- Center of Clinical Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xu Chen
- Center of Clinical Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yalu Ren
- Center of Clinical Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Lina Zhao
- Center of Clinical Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Department of Laboratory Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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9
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Huang W, Qiao F, Deng Y, Zhu S, Li J, Zong Z, Zhang W. Analysis of risk factors associated with healthcare-associated carbapenem-resistant Klebsiella pneumoniae infection in a large general hospital: a case-case-control study. Eur J Clin Microbiol Infect Dis 2023; 42:529-541. [PMID: 36856898 PMCID: PMC9975449 DOI: 10.1007/s10096-023-04578-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/16/2023] [Indexed: 03/02/2023]
Abstract
Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection is a major public health threat in the world. To inform the prevention and control of CRKP infection in hospitals, this study analyzed the factors associated with CRKP infection and resistance to carbapenems in K. pneumoniae. This case-case-control study was carried out in a large general hospital in China from January 2016 to December 2018, comprising 494 hospitalized patients infected with CRKP (case group 1) and 2429 hospitalized patients infected with carbapenem-susceptible K. pneumoniae (CSKP, case group 2). We selected control groups from hospitalized patients without K. pneumoniae infections for the two case groups separately, with a 1:3 case-control ratio, to analyze the risk factors of the two case groups using the conditional logistic regression. Multivariate analysis showed that the risk factors of CRKP infection were intensive care unit (ICU) admission (odds ratio [OR], 6.85; 95% confidence interval [CI], 4.90-9.58; P < 0.001), respiratory failure (OR, 1.93; 95% CI, 1.34-2.77; P < 0.001), age-adjusted Charlson comorbidity index (aCCI; OR, 1.08; 95% CI, 1.02-1.15; P = 0.007), admission from the Emergency (OR, 1.37; 95% CI, 1.02-1.85; P = 0.036), and imipenem use (OR, 1.80; 95% CI, 1.30-2.49; P < 0.001). Among the aforementioned five risk factors, aCCI (OR, 1.09; 95% CI, 1.06-1.13; P < 0.001) was also identified as a risk factor of CSKP infections in multivariate analysis. The risk factors for resistance to carbapenems in K. pneumoniae were ICU admission, respiratory failure, admission from the Emergency, and imipenem use.
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Affiliation(s)
- Wenzhi Huang
- grid.412901.f0000 0004 1770 1022Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan China ,grid.412901.f0000 0004 1770 1022Department of Infection Control, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Fu Qiao
- grid.412901.f0000 0004 1770 1022Department of Infection Control, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Yuhua Deng
- grid.412901.f0000 0004 1770 1022Department of Infection Control, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Shichao Zhu
- grid.412901.f0000 0004 1770 1022Department of Infection Control, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Jingwen Li
- grid.412901.f0000 0004 1770 1022Department of Infection Control, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Zhiyong Zong
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Wei Zhang
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China. .,West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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10
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Li M, Yang S, Yao H, Liu Y, Du M. Retrospective Analysis of Epidemiology, Risk Factors, and Outcomes of Health Care-Acquired Carbapenem-Resistant Klebsiella pneumoniae Bacteremia in a Chinese Tertiary Hospital, 2010-2019. Infect Dis Ther 2023; 12:473-485. [PMID: 36520329 PMCID: PMC9925657 DOI: 10.1007/s40121-022-00732-7] [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: 07/09/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION In the present study, we aimed to describe the proportion of carbapenem-resistant Klebsiella pneumoniae bloodstream infection (CRKP-BSI) in KP-BSI in one Chinese tertiary hospital over 10 years and determine the risk factors and outcomes of CRKP-BSI. METHODS We retrospectively analyzed clinical and microbiological data of patients with KP-BSI from January 2010 to December 2019 to identify risk factors, clinical features, and outcomes using multivariate logistic regression analysis. KP-BSI only included monomicrobial BSI and health care-acquired BSI. RESULTS Among the total 687 isolates of KP-BSI in this study, the rate of CRKP was 39.0% (268/687); this rate in the intensive care unit (ICU) was 65.6% and that in seven high-risk departments (including four ICUs, respiratory medicine, gastroenterology medicine, and hepatobiliary surgery) was 74.6%. The annual rate of CRKP in KP-BSI ranged from 0.0% in 2010 to 54.5% in 2019. The 28-day mortality was 36.2% in patients with CRKP-BSI and 11.7% in those with carbapenem-susceptible K. pneumoniae (CSKP) BSI. Multivariable logistic regression analysis showed that prior ICU stay (odds ratio [OR] 2.485, P < 0.001), hospital stay ≥ 30 days prior to BSI (OR 1.815, P = 0.007), prior mechanical ventilation (OR 2.020, P = 0.014), prior urinary catheter (OR 1.999, P = 0.003), prior carbapenem use (OR 3.840, P < 0.001), hepatobiliary disease (OR 2.943, P < 0.001), pancreatitis (OR 2.700, P = 0.026), and respiratory disease (OR 2.493, P = 0.009) were risk factors of CRKP-BSI. Patients with a first admission (OR 0.662, P = 0.046) had a lower percentage of CRKP-BSI. CONCLUSION The rapidly rising rate of CRKP-BSI in KP with high mortality requires increased attention. Exposure to carbapenems, ICU stay, invasive mechanical ventilation or urinary catheter, prolonged hospital stay, hepatobiliary disease, pancreatitis, and respiratory disease were found to be risk factors for CRKP-BSI. Strict control measures should be implemented to prevent the emergence and spread of CRKP, especially in high-risk departments.
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Affiliation(s)
- Meng Li
- Department of Hematology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shanshan Yang
- Department of Disease Prevention and Control, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing, 100853 China
| | - Hongwu Yao
- Department of Disease Prevention and Control, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing, 100853 China
| | - Yunxi Liu
- Department of Disease Prevention and Control, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing, 100853 China
| | - Mingmei Du
- Department of Disease Prevention and Control, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Rd, Haidian District, Beijing, 100853 China
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11
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Clinical and Molecular Characterizations of Carbapenem-Resistant Klebsiella pneumoniae Causing Bloodstream Infection in a Chinese Hospital. Microbiol Spectr 2022; 10:e0169022. [PMID: 36190403 PMCID: PMC9603270 DOI: 10.1128/spectrum.01690-22] [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] [Indexed: 01/10/2023] Open
Abstract
Bloodstream infection (BSI) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) is a serious and urgent threat for hospitalized patients. This study aims to describe the clinical and molecular characteristics of CRKP causing BSI in a tertiary-care hospital in Beijing, China. A total of 146 CRKP strains and 39 carbapenem-susceptible K. pneumoniae (CSKP) strains collected in the hospital from 2017 to 2020 were sent for whole-genome sequencing. Univariate and multivariate analyses were used to evaluate risk factors for in-hospital mortality of CRKP-BSI cases. Thirty (20.5%) of 146 CRKP-BSI patients and three (7.7%) of 39 CSKP-BSI patients died at discharge (χ2 = 3.471, P = 0.062). Multivariate logistic regression analysis indicated that age and use of urinary catheters were independent risk factors for the death of CRKP-BSI. The 146 CRKP isolates belonged to 9 sequence types (STs) and 11 serotypes, while the 39 CSKP isolates belonged to 23 STs and 27 serotypes. The mechanism of carbapenem resistance for all the CRKP strains was the acquisition of carbapenemase, mainly KPC-2 (n = 127). There were 2 predominant serotypes for ST11 CRKP, namely, KL47 (n = 82) and KL64 (n = 42). Some virulent genes, including rmpA2, iucABCD and iutA, and repB gene, which was involved in plasmid replication, were detected in all ST11-KL64 strains. Evolutionary transmission analysis suggested that ST11 CRKP strains might have evolved from KL47 into KL64 and were accompanied by multiple outbreak events. This study poses an urgent need for enhancing infection control measures in the hospital, especially in the intensive care unit where the patients are at high-risk for acquiring CRKP-BSI. IMPORTANCE CRKP-BSI is demonstrated to cause high mortality. In this study, we demonstrated that ST11 CRKP strains might carry many virulent genes. Meanwhile, outbreak events occurred several times in the strains collected. Carbapenemase acquisition (mainly KPC-2 carbapenemase) was responsible for carbapenem resistance of all the 146 CRKP strains. As 2 predominant strains, all ST11-KL64 strains, but not ST11-KL47 strains, carried rmpA2, iucABCD, iutA, as well as a plasmid replication initiator (repB). Our study suggested that the occurrence of region-specific recombination events manifested by the acquisition of some virulence genes might contribute to serotype switching from ST11-KL47 to ST11-KL64. The accumulation of virulent genes in epidemic resistant strains poses a great challenge for the prevention and treatment of BSI caused by K. pneumoniae in high-risk patients.
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Elsawah H, Samir A, Elrazzaz M, Ramadan A, Elnaggar A, Taema K. Carbapenems consumption and Klebsiella resistance in intensive care units in Egypt: A study to evaluate the effect of an antimicrobial stewardship program. J Infect Prev 2022; 23:142-148. [PMID: 37256159 PMCID: PMC10226057 DOI: 10.1177/17571774211060436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 08/31/2021] [Indexed: 09/20/2023] Open
Abstract
Background The high prevalence of carbapenem-resistant Klebsiella imposes optimizing antibiotic consumption. We aimed to evaluate the impact of antibiotic stewardship program on carbapenem consumption and the Klebsiella resistance. Method We retrospectively evaluated critically ill patients with isolated Klebsiella species from Elaraby hospital, Egypt during the period from April 2017 to January 2019. We collected data related to carbapenems consumption and Klebsiella clinical isolates with their antimicrobial susceptibility. Based on susceptibility, Klebsiella isolates were classified into sensitive, extended spectrum beta-lactamase (ESBL) producer, and carbapenem-resistant Klebsiella (CRK), respectively. Our primary outcome was the change in carbapenems consumption after implementing the program, while the secondary outcomes were the changes in the incidence of CRK. Results The study included 205 patients with isolated Klebsiella species during the study period. The antibiotic stewardship program started in March 2018. Out of the 205 patients, 61 patients (29.8%) represented the pre-intervention sample, and 144 patients (70.2%) represented the post-intervention sample. Applying the antibiotic stewardship program was associated with a significant decrease in the carbapenems consumption from 38.9 to 26.6 defined daily dose/1000 patient-days (p = 0.02). The incidence of CRK was decreased from 85.25% of total Klebsiella isolates to 48.6% (p < 0.001). Klebsiella species were more likely to be in a lower category of resistance after applying the program with an odds ratio of 6.3 (2.88-13.73) using ordinal logistic regression. Conclusion Applying the antibiotic stewardship program could reduce the unnecessary carbapenems use in the ICU with a subsequent decrease in the emergence of the Klebsiella-resistant strains.
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Affiliation(s)
- Hozaifa Elsawah
- Biostatistics Department, High Institute of Public Health, Alexandria University, Egypt
| | | | | | | | | | - Khaled Taema
- Critical Care Department, Kasr Alainy Hospitals, Cairo University, Egypt
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13
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Chen Y, Ying S, Jiang L, Dong S, Dai J, Jin X, Yu W, Qiu Y. A Novel Nomogram for Predicting Risk Factors and Outcomes in Bloodstream Infections Caused by Klebsiella pneumoniae. Infect Drug Resist 2022; 15:1317-1328. [PMID: 35378894 PMCID: PMC8976504 DOI: 10.2147/idr.s349236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 03/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Our study aimed to explore the risk factors in bloodstream infections Klebsiella pneumoniae (BSI-KP) patients and establish nomograms to predict the probability of BSI-CRKP and the prognosis of BSI-KP. Methods A total of 252 BSI-KP patients were enrolled from a tertiary teaching hospital between January 1, 2015, and May 31, 2020. Risk factors associated with BSI-CRKP and factors associated with the 30-day mortality were identified using LASSO analysis, univariate and multivariate analysis. Results There were 121 (48.0%) patients with carbapenem-resistant K. pneumoniae (CRKP) and 131 (52.0%) patients with carbapenem-susceptible K. pneumoniae (CSKP). The multivariate logistic regression analysis demonstrated that gastric tube indwelling before BSI (OR=2.442, P=0.043) and more types of antibiotics use before BSI (OR=1.305, P=0.009) were independent risk factors for BSI-CRKP. And previous transplantations, prior ICU stay, gastric tube indwelling before BSI, more types of antibiotics use before BSI, lower Hb and cholinesterase were associated with CRKP-BSI. The C-index of models indicated its good accuracy (C-index 0.816, 95% CI 0.763–0.868). In patients with BSI-CRKP, further logistic regression analysis revealed urinary catheterization (OR=0.298, P=0.017) was found to be an independent risk factor for 30-day mortality, while ceftazidime/avibactam use (OR=8.438, P=0.003) was an independent favorable prognostic factor. The nomogram predicated CRKP, ICU hospitalization, more types of antibiotics use, tigecycline, PLT, urinary catheterization were associated with 30-day mortality in patients with BSI-KP. The discriminative ability of the predictive model, as assessed by C-index, was 0.813 (95% CI: 0.780–0.867). Conclusion Previous transplantations, prior ICU stay, gastric tube indwelling before BSI, more types of antibiotics use before BSI, lower Hb and cholinesterase represent significant risk factors for the development of BSI-CRKP. Our nomogram predicated thrombocytopenia was a sign for poor prognosis. Tigecycline resulted in higher mortality for patients with BSI-KP. Rational use of nomograms may help clinicians make better Clinical decisions when treating BSI-KP patients.
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Affiliation(s)
- Yingsha Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Infectious Diseases, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Shuaibing Ying
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Lushun Jiang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Shaohua Dong
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Jinyao Dai
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Xuehang Jin
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Wei Yu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Correspondence: Wei Yu; Yunqing Qiu, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China, Tel +86-571-87236606, Fax +86-571-87236606, Email ;
| | - Yunqing Qiu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
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14
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Jing N, Yan W, Zhang Q, Yuan Y, Wei X, Zhao W, Guo S, Guo L, Gao Y, Zhao L, Shi C, Li Y. Epidemiology and genotypic characteristics of carbapenem resistant Enterobacterales in Henan, China: A multicentre study. J Glob Antimicrob Resist 2022; 29:68-73. [DOI: 10.1016/j.jgar.2022.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/29/2022] [Accepted: 01/31/2022] [Indexed: 11/28/2022] Open
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Chen TM, Li WH, Wang F, Tan K, Zhu QX, Zhou K, Liu SH, Liu J, Bi J, Deng HL, Chen XX, Li J, Wang YM, Zhao Q, Zhu L, Ma HX, Li Z, Deng JK, Zhu CH, Wu KK, Lin AW, Li SJ, Wang DM, Cai HJ, Zhao SY, Lu XD, Ye L, Dong F, Zhang WS, Yang YH, Liu G. Antibiotics prescription for targeted therapy of pediatric invasive pneumococcal diseases in China: a multicenter retrospective study. BMC Infect Dis 2021; 21:1156. [PMID: 34775956 PMCID: PMC8591947 DOI: 10.1186/s12879-021-06860-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background Streptococcus pneumoniae (S. pneumoniae) is a major cause of bacterial meningitis, septicemia and pneumonia in children. Inappropriate choice of antibiotic can have important adverse consequences for both the individual and the community. Here, we focused on penicillin/cefotaxime non-susceptibility of S. pneumoniae and evaluated appropriateness of targeted antibiotic therapy for children with IPD (invasive pneumococcal diseases) in China. Methods A multicenter retrospective study was conducted in 14 hospitals from 13 provinces in China. Antibiotics prescription, clinical features and resistance patterns of IPD cases from January 2012 to December 2017 were collected. Appropriateness of targeted antibiotics therapy was assessed. Results 806 IPD cases were collected. The non-susceptibility rates of S. pneumoniae to penicillin and cefotaxime were 40.9% and 20.7% respectively in 492 non-meningitis cases, whereas those were 73.2% and 43.0% respectively in 314 meningitis cases. Carbapenems were used in 21.3% of non-meningitis cases and 42.0% of meningitis cases for targeted therapy. For 390 non-meningitis cases with isolates susceptible to cefotaxime, vancomycin and linezolid were used in 17.9% and 8.7% of cases respectively for targeted therapy. For 179 meningitis cases with isolates susceptible to cefotaxime, vancomycin and linezolid were prescribed in 55.3% and 15.6% of cases respectively. Overall, inappropriate targeted therapies were identified in 361 (44.8%) of 806 IPD cases, including 232 (28.8%) cases with inappropriate use of carbapenems, 169 (21.0%) cases with inappropriate use of vancomycin and 62 (7.7%) cases with inappropriate use of linezolid. Conclusions Antibiotic regimens for IPD definite therapy were often excessive with extensive prescription of carbapenems, vancomycin or linezolid in China. Antimicrobial stewardship programs should be implemented to improve antimicrobial use.
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Affiliation(s)
- Tian-Ming Chen
- Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nalishi Road 56#, Xicheng, Beijing, 100045, China
| | - Wen-Hui Li
- Department of Infection, Hebei Children's Hospital, Shijiazhuang, China
| | - Fang Wang
- Infectious Diseases Department, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Kun Tan
- Division of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, China
| | - Qing-Xiong Zhu
- Department of Infectious Disease, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Kai Zhou
- Department of Infection, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Shi-Hua Liu
- Department of Infectious Disease, Children's Hospital of Jinan, Jinan, China
| | - Jing Liu
- Department of Infection, Hunan Children's Hospital, Changsha, China
| | - Jing Bi
- Infection Division, Baoding Children's Hospital, Baoding, China
| | - Hui-Ling Deng
- Department 2 of infection, Xi'an Children's Hospital, Xi'an, China
| | - Xue-Xia Chen
- Department of Infectious Disease, Hangzhou Children's Hospital, Hangzhou, China
| | - Juan Li
- Department of Infectious Diseases, Urumqi Children's Hospital, Urumqi, China
| | - Yu-Min Wang
- Department of Pediatrics, Maternal and Child Health Care Hospital of Inner Mongolia, Hohhot, China
| | - Qing Zhao
- Department of Infectious Diseases, Children's Hospital of Shanxi, Taiyuan, China
| | - Liang Zhu
- Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nalishi Road 56#, Xicheng, Beijing, 100045, China
| | - Hui-Xuan Ma
- Department of Infection, Hebei Children's Hospital, Shijiazhuang, China
| | - Zhi Li
- Infectious Diseases Department, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Ji-Kui Deng
- Division of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, China
| | - Chun-Hui Zhu
- Department of Infectious Disease, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Kang-Kang Wu
- Department of Infection, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Ai-Wei Lin
- Department of Infectious Disease, Children's Hospital of Jinan, Jinan, China
| | - Shuang-Jie Li
- Department of Hepatology, Hunan Children's Hospital, Changsha, China
| | - Dong-Meng Wang
- Infection Division, Baoding Children's Hospital, Baoding, China
| | - Hui-Jun Cai
- Clinical Laboratory, Xi'an Children's Hospital, Xi'an, China
| | - Shi-Yong Zhao
- Department of Infectious Disease, Hangzhou Children's Hospital, Hangzhou, China
| | - Xu-Dong Lu
- Department of Infectious Diseases, Urumqi Children's Hospital, Urumqi, China
| | - Lan Ye
- Department of Pediatrics, Maternal and Child Health Care Hospital of Inner Mongolia, Hohhot, China
| | - Fang Dong
- Department of Infectious Diseases, Children's Hospital of Shanxi, Taiyuan, China
| | - Wen-Shuang Zhang
- Department of Respiratory Medicine, Tianjin Children's Hospital, Tianjin, China
| | - Yong-Hong Yang
- Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Gang Liu
- Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nalishi Road 56#, Xicheng, Beijing, 100045, China.
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16
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Zhang H, Wang J, Zhou W, Yang M, Wang R, Yan X, Cai Y. Risk Factors and Prognosis of Carbapenem-Resistant Klebsiella pneumoniae Infections in Respiratory Intensive Care Unit: A Retrospective Study. Infect Drug Resist 2021; 14:3297-3305. [PMID: 34447257 PMCID: PMC8382964 DOI: 10.2147/idr.s317233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/28/2021] [Indexed: 01/10/2023] Open
Abstract
Purpose Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections have become a serious threat with high morbidity and mortality. Early identification of risk factors for CRKP infections is important, but these factors are still controversial. Therefore, we aimed to identify the risk factors and clinical outcomes of CRKP infections. Patients and Methods The retrospective, single-center study was carried out in the respiratory intensive care unit of the Chinese People’s Liberation Army General Hospital from 2017 to 2020. Patients infected with K. pneumoniae were included and categorized into the CRKP group and carbapenem-sensitive K. pneumoniae (CSKP) group based on the susceptibility to carbapenems. The independent risk factors were investigated by univariate analysis and multivariate logistic regression analysis. The clinical outcomes were also evaluated between the two groups. Results A total of 138 eligible patients were included in our study, with a median age of 80.5 years (interquartile range: 62.0–86.3), and 78.3% of them were males. Of the 138 patients, there were 97 patients in the CRKP group, and the other 41 were assigned into the CSKP group. Multivariate analysis showed that exposure to ≥three types of comorbidities (OR = 5.465, P = 0.003), previous hospitalization (OR = 4.279, P = 0.006), use of quinolones (OR = 5.872, P = 0.012), and indwelling urinary catheter (OR = 5.035, P = 0.000) were independent risk factors for CRKP infections. The in-hospital mortality rate of the CRKP group was 42.1%, which was higher compared with the CSKP group (17.5%, P = 0.006). Conclusion Exposure to ≥three types of comorbidities, previous hospitalization, use of quinolones, and indwelling urinary catheter were independent risk factors for CRKP infections, which had higher mortality compared with CSKP infections. Early detection of high-risk patients and timely control measures should be implemented to prevent the emergence of CRKP infections and thereby improve the clinical outcomes.
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Affiliation(s)
- Huan Zhang
- Centre of Medicine Clinical Research, Department of Pharmacy, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China.,College of Pharmacy, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Jin Wang
- Centre of Medicine Clinical Research, Department of Pharmacy, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Weiying Zhou
- College of Pharmacy, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Ming Yang
- Centre of Big Data, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Rui Wang
- Centre of Medicine Clinical Research, Department of Pharmacy, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Xin Yan
- College of Laboratory Medicine, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Yun Cai
- Centre of Medicine Clinical Research, Department of Pharmacy, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
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