Epidemiology, management, and outcome of carbapenem-resistant Klebsiella pneumoniae bloodstream infections in hospitals within the same endemic metropolitan area

Abstract

In the last decade, carbapenem-resistant Klebsiella pneumoniae (CR-Kp) has become endemic in several countries, including Italy. In the present study, we assessed the differences in epidemiology, management, and mortality of CR-Kp bloodstream infection (BSI) in the three main adult acute-care hospitals of the metropolitan area of Genoa, Italy. From January 2013 to December 2014, all patients with CR-Kp BSI were identified through the computerized microbiology laboratory databases of the three hospitals. The primary endpoints of the study were incidence and characteristics of CR-Kp BSI in hospitals within the same endemic metropolitan area. Secondary endpoints were characteristics of CR-Kp BSI in hospitals with and without internal infectious diseases consultants (IDCs) and 15-day mortality. During the study period, the incidence of healthcare-associated CR-Kp BSI in the entire study population was 1.35 episodes per 10,000 patient-days, with substantial differences between the three hospitals. Patients admitted to the two hospital with internal IDCs were more likely to receive post-susceptibility test combined therapy including carbapenems (77% vs. 26%, p<0.001), adequate post-susceptibility test therapies (86% vs. 52%, p<0.001), and post-susceptibility therapies prescribed by an infectious diseases specialist (84% vs. 14%, p<0.001). Overall, the crude 15-days mortality was 26%. In the final multivariable model, only septic shock at BSI presentation was unfavorably and independently associated with 15-days mortality (odds ratio [OR] 6.7, 95% confidence intervals [CI] 2.6-17.6, p<0.001), while a protective effect was observed for post-susceptibility test combined therapies including a carbapenem (OR 0.11, 95% CI 0.03-0.43, p=0.002). Mortality of CR-Kp remains high. Differences in the incidence of CR-Kp BSI were detected between acute-care centers within the same endemic metropolitan area. Efforts should be made to improve the collaboration and coordination between centers, to prevent further diffusion of CR-Kp.

Infections Due to Carbapenem-Resistant Bacteria in Patients With Hematologic Malignancies

“…In HM patients, this species is the most widespread etiological bacterium in the world, detected in infections occurring in this group (Tables 2-4). CR K. pneumoniae was detected mainly as rectal colonization (Cattaneo et al, 2018;Jaiswal et al, 2018), CR-bacteria BSIs (Satlin et al, 2016), and nosocomial CR infection cases (Hussein et al, 2013;Cristina et al, 2017;Jaiswal et al, 2018).…”

Tigecycline application in a 3-month-old infant with multiple drug resistant Klebsiella pneumonia: a case report

“…The potential danger of super bacteria is alarming, physicians may not use any effective medicine in their treatments, regardless of meropenem, vancomycin, or linezolid etc. The 15-days mortality of carbapenem-resistant Klebsiella pneumoniae could reach up to 26% [ 8 ]. It could be more fatal for neonates with a weaker immune system compared with elder children and adults.…”

Complete Genome Sequence of Klebsiella pneumoniae Phages SopranoGao, MezzoGao, and AltoGao

“…Klebsiella pneumoniae is a Gram-negative bacterium in the Enterobacteriaceae family and is increasingly associated with nosocomial infections in humans ( 1 ). Here, we describe the complete genomes of SopranoGao, MezzoGao, and AltoGao bacteriophages active against K. pneumoniae .…”