Colistin-resistant Klebsiella pneumoniae bloodstream infection: old drug, bad bug

Ben‐Chetrit, Eli; McGann, Patrick; Maybank, Rosslyn; Stam, Jason; Assous, Marc V.; Katz, David

doi:10.1007/s00203-021-02289-4

Cited by 7 publications

(3 citation statements)

References 27 publications

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“…It facilitates instantaneous identification of all bacterial species, resistance, lineage, and virulence determinants [63] , [64] . Many blood isolates of CRKP from Israel have been explored using WGS to reveal the mechanisms of colistin resistance [65] . WGS is quickly gaining attention as a key method for surveillance and epidemiological investigations of K. pneumoniae because of its ability to reveal the complexity and genetic relatedness of the bacterium.…”

Section: Molecular Typing Of K Pneumoniaementioning

confidence: 99%

Molecular typing methods & resistance mechanisms of MDR Klebsiella pneumoniae

2023

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<abstract> The emergence and transmission of carbapenem-resistant <italic>Klebsiella pneumoniae</italic> (CRKP) have been recognized as a major public health concern. Here, we investigated the molecular epidemiology and its correlation with the mechanisms of resistance in CRKP isolates by compiling studies on the molecular epidemiology of CRKP strains worldwide. CRKP is increasing worldwide, with poorly characterized epidemiology in many parts of the world. Biofilm formation, high efflux pump gene expression, elevated rates of resistance, and the presence of different virulence factors in various clones of <italic>K. pneumoniae</italic> strains are important health concerns in clinical settings. A wide range of techniques has been implemented to study the global epidemiology of CRKP, such as conjugation assays, 16S-23S rDNA, string tests, capsular genotyping, multilocus sequence typing, whole-genome sequencing-based surveys, sequence-based PCR, and pulsed-field gel electrophoresis. There is an urgent need to conduct global epidemiological studies on multidrug-resistant infections of <italic>K. pneumoniae</italic> across all healthcare institutions worldwide to develop infection prevention and control strategies. In this review, we discuss different typing methods and resistance mechanisms to explore the epidemiology of <italic>K. pneumoniae</italic> pertaining to human infections. </abstract>

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Section: Molecular Typing Of K Pneumoniaementioning

confidence: 99%

Molecular typing methods & resistance mechanisms of MDR Klebsiella pneumoniae

2023

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“…Previous studies have shown that colistin has a satisfactory effect on multi-drug-resistant gram-negative bacilli infections, and it is widely used worldwide [12,13]. However, with the increasing use of antibiotics and the screening of drugs for bacterial resistance, colistinresistant bacteria have appeared [14][15][16][17]. In an attempt to reduce bacterial resistance, research is beginning to focus on colistin combination therapy, for example, colistin combined with tigecycline [18,19] or meropenem [20].…”

Section: Introductionmentioning

confidence: 99%

Ceftazidime/avibactam combined with colistin: a novel attempt to treat carbapenem- resistant gram-negative bacilli infection

Zheng,

Shao,

et al. 2023

Preprint

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Background The rapid global emergence and spread of carbapenem-resistant gram-negative bacilli (CRO) is recognized as a major public health concern, and there are currently few effective treatments for CRO infection. The aim of this study was to investigate the clinical characteristics and outcomes of patients with CRO infections treated with ceftazidime/avibactam (CAZ/AVI) combined with colistin from October 2019 to February 2023 in China. Methods A total of 31 patients with CRO infections were retrospectively identified using the electronic medical record system of Zhejiang Provincial People's Hospital. Results Thirty-one patients were treated with CAZ/AVI combined with colistin. Respiratory tract infections (27/31, 87%) were most common. Pathogens included carbapenem-resistant Klebsiella pneumoniae (17/31, 54.8%), carbapenem-resistant Acinetobacter baumannii (9/31, 29.0%), and carbapenem-resistant Pseudomonas aeruginosa (5/31, 16.1%). The 30-day mortality rate was 29.0%, and the average lengths of hospital and ICU stay among all patients were 39.0 and 17.0 days, respectively. The average lengths of ICU stay among the survivors and non-survivors were 19.7 and 10.7 days, respectively (P = 0.023). In addition, the pathogen was cleared within 7 days in 20 patients (20/31, 64.5%). Among all patients, average levels of the inflammatory indicator CRP were significantly lower 7 (152.23 ± 68.42 mg/L vs 94.56 ± 56.86 mg/L, P = 0.002) and 14 (152.23 ± 68.42 mg/L vs 83.20 ± 55.87 mg/L, P = 0.005) days after combination therapy than levels 24 h before therapy. Similarly, CRP levels among the survivors were significantly lowered by treatment, with 145.61 ± 70.42 mg/L vs 94.82 ± 53.76 mg/L (P = 0.018) at 7 days and 145.61 ± 70.42 mg/L vs 86.16 ± 57.98 mg/L (P = 0.027) at 14. However, there were no significant differences in PCT or WBC levels among all patients or among survivors. Conclusions CAZ/AVI combined with colistin reduced the inflammatory response in patients with CRO infection, but more studies will be needed to determine whether the combination can increase the 7-day microbial clearance rate and reduce the 30-day mortality rate.

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“…Fakat son yıllarda, edinilmiş kolistin direnci olguları bildirilmektedir. Kolistin direncinin kazanılmasına ya bir plazmitin (mcr-1 ve mcr-2) aracılık ettiği ya da iki bileşenli PhoP/PhoQ ve PmrAB düzenleyici sistemlerindeki değişikliklerin veya mgrB dizisinin kesintiye uğramasının neden olduğu bulunmuştur (6) . Plazmit aracılı kolistin direncine yol açan mcr-1 proteini ilk kez 2015 yılında Escherichia coli ve Klebsiella pneumoniae izolatlarında tanımlanmış ve bunu takiben 2016 yılında mcr-2 proteini tanımlanmıştır.…”

Section: Introductionunclassified

Determination of Colistin Resistance in Gram Negative Bacteria by Modified Broth Disk Elution Method

Tüzemen¹,

Işık²,

Akça³

et al. 2022

Turk Mikrobiyol Cemiy Derg

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Amaç: Çalışmamız, kolistin direncini malzeme ve iş yükünden tasarruf ederek sıvı disk elüsyon (SDE) yönteminde kullanılan tüp ve kolistin diski sayısını azaltarak, iş yükü fazla olan tıbbi mikrobiyoloji laboratuvarlarının kullanabileceği alternatif bir yöntemi sunmak ve referans yöntem ile performansını karşılaştırmak amacıyla yapılmıştır. Yöntem: Hastanemizde 2020-2022 yılları arasında çeşitli klinik örneklerden izole edilen 100 adet otomatize sistem ile kolistin duyarlı, 50 adet kolistin dirençli Gram negatif bakteri çalışmaya alınmıştır. Tek tüp ile yapılan modifiye SDE yönteminin ve otomatize sistemin sonuçları, referans yöntem olan sıvı mikrodilüsyon (SMD) yöntemi ile kategorik uyum (KU),çok büyük hata (ÇBH) ve büyük hata (BH) oranları ile karşılaştırılmıştır. Bulgular: Otomatize sistemin tüm izolatlarda KU %86, ÇBH oranı %10.7 ve BH oranı %3.3 olarak bulunmuştur. Modifiye SDE yönteminin ise tüm izolatlarda KU %80, ÇBH oranı %4 ve BH oranı %16 olarak bulunmuştur. Otomatize sistemde ÇBH olarak yorumlanan 16 izolatın 10'u (%62.5) modifiye SDE yönteminde olması gerektiği gibi dirençli, BH olarak yorumlanan beş izolatın üçü (%60) ise modifiye SDE yönteminde olması gerektiği gibi duyarlı olarak saptanmıştır. Sonuç: Çoğu mikrobiyoloji laboratuvarında antibiyotik duyarlılık testinde kullanılan otomatize sistemin KU'mu ISO standartlarına yakın olmasına rağmen, kolistin duyarlılığı açısından ÇBH oranının çok fazla olduğu, bunların modifiye SDE yöntemi ile çalışıldığında bu oranın azaldığı saptanmıştır. Özellikle günlük antibiyogram sayısı fazla olan mikrobiyoloji laboratuvarlarında kolistin duyarlılık sonuçlarının SMD yöntemi ile çalışılamadığı durumlarda, Enterobacteriaceae ve Pseudomonas spp. izolatlarında otomatize sistemde kolistin duyarlı ise modifiye SDE yöntemi ile çalışılmasının daha güvenilir bir sonuç verdiği görülmüştür.

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Colistin-resistant Klebsiella pneumoniae bloodstream infection: old drug, bad bug

Cited by 7 publications

References 27 publications

Molecular typing methods & resistance mechanisms of MDR <i>Klebsiella pneumoniae</i>

Molecular typing methods & resistance mechanisms of MDR <i>Klebsiella pneumoniae</i>

Ceftazidime/avibactam combined with colistin: a novel attempt to treat carbapenem- resistant gram-negative bacilli infection

Determination of Colistin Resistance in Gram Negative Bacteria by Modified Broth Disk Elution Method

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Colistin-resistant Klebsiella pneumoniae bloodstream infection: old drug, bad bug

Cited by 7 publications

References 27 publications

Molecular typing methods &amp; resistance mechanisms of MDR <i>Klebsiella pneumoniae</i>

Molecular typing methods &amp; resistance mechanisms of MDR <i>Klebsiella pneumoniae</i>

Ceftazidime/avibactam combined with colistin: a novel attempt to treat carbapenem- resistant gram-negative bacilli infection

Determination of Colistin Resistance in Gram Negative Bacteria by Modified Broth Disk Elution Method

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Molecular typing methods & resistance mechanisms of MDR <i>Klebsiella pneumoniae</i>

Molecular typing methods & resistance mechanisms of MDR <i>Klebsiella pneumoniae</i>