Analysis of Risk Factors for Carbapenem-Resistant Klebsiella pneumoniae Infection and Its Effect on the Outcome of Early Infection After Kidney Transplantation

Zhang, Fei; Zhong, Jinbiao; Ding, Hong; Pan, Jiashan; Yang, Jing; Lan, Tianchi; Chen, Yiding; Liao, Gaoliang

doi:10.3389/fcimb.2021.726282

Cited by 13 publications

(17 citation statements)

References 27 publications

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“…A previous study reported that CRKP appeared to be an independent risk factor for 1-year postoperative mortality in patients after kidney transplantation ( 44 ). Additionally, some studies demonstrated that CRKP infection was one of the independent risk factors for death from Kp bloodstream infection ( 45 , 46 ).…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes and Microbiological Characteristics of Sequence Type 11 Klebsiella pneumoniae Infection

Yang

Liu

et al. 2022

Front. Med.

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BackgroundSequence type 11 (ST11) Klebsiella pneumoniae (Kp) is highly prevalent in China and is a typical sequence type among KPC-producing isolates. This study aimed to evaluate the clinical outcomes and microbiological features of ST11 Kp infections.MethodsA retrospective cohort study was conducted at Peking University Third Hospital from January 2017 to March 2021. Clinical data were collected from medical records. Antimicrobial susceptibility testing and string tests were performed. Whole-genome sequencing was used to analyze the capsular serotypes, detect virulence-associated genes, and perform multilocus sequence typing. The risk of all-cause mortality in ST11 Kp-infected patients was compared to that in non-ST11 Kp-infected patients.ResultsFrom 139 patients infected with Kp, 49 ST11 Kp (35.3%) strains were isolated. The Charlson comorbidity index in the ST11 group was higher than that in the non-ST11 group (3.94 ± 1.59 vs. 2.41 ± 1.54, P = 0.001). A greater number of ST11 Kp-infected patients required ICU admission (46.9 vs. 16.7%, P < 0.001) and mechanical ventilation (28.6 vs. 10.0%, P = 0.005). All ST11 isolates presented a multidrug-resistant (MDR) phenotype, and twenty-nine (59.2%) hypervirulent Kp (hvKp) were identified. Twenty-four ST11 strains presented with hypermucoviscosity. The presence of capsular types K47 and K64 was frequent in the ST11 Kp strains (P < 0.001). The key virulence-associated genes rmpA, rmpA2, iucA, iroB, and peg344 were present in 26.5, 42.9, 59.2, 0, and 26.5% of the isolates, respectively, in the ST11 group. Twenty-one ST11 isolates harbored the combination of iucA+rmpA2. The 30-day mortality rate and sequential organ failure assessment (SOFA) score were significantly higher in ST11 Kp-infected patients than in non-ST11 Kp-infected patients (P < 0.01). ST11 Kp infection appeared to be an independent risk factor for mortality in ST11 Kp-infected patients.ConclusionsA high prevalence of the ST11 clone was found in the hospital, which accounted for elevated antimicrobial resistance and exhibited great molecularly inferred virulence. Patients with ST11 Kp infection had a tendency toward increased 30-day mortality and SOFA scores. ST11 Kp infection was an independent risk factor for mortality, suggesting that enhanced surveillance and management are essential.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes and Microbiological Characteristics of Sequence Type 11 Klebsiella pneumoniae Infection

Yang

Liu

et al. 2022

Front. Med.

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“…The results suggest that CRKP isolation is associated with high in-hospital mortality, which is similar to those reported in previous publications. 29 , 30 …”

Section: Discussionmentioning

confidence: 99%

Analysis of Risk Factors and Mortality of Patients with Carbapenem-Resistant Klebsiella pneumoniae Infection

Wu¹,

Zheng²,

Yao³

2022

IDR

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Background Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection is associated with high mortality and has become a major public problem threatening patients. This study aimed to explore risk factors for death in patients with Klebsiella pneumoniae (KP) and identify risk factors for CRKP infection. Methods The study retrospectively analyzed clinical characteristics and microbiological data from patients infected with KP from January 2019 to October 2021 to identify risk factors and mortality, using multivariate logistic regression analysis and Cox regression analysis. Results A total of 214 KP inpatients were enrolled in our study. The in-hospital mortality rate was significantly higher in patients infected with CRKP (13/68, 19.12%) than carbapenem-susceptible KP (CSKP) (2/146, 1.37%) and the difference was statistically significant (P= 0.03). Multivariate Cox regression analysis showed CRKP isolation (HR 12.26, 95% CI 2.43–61.68, P = 0.002), lower TP (HR 10.50, 95% CI 1.33–82.76, P = 0.03), antibiotic days of therapy >15 (HR 0.08, 95% CI 0.01–0.56, P= 0.01) and length of stay (LOS) (HR 0.03, 95% CI 0.002–0.61, P= 0.02) were independent risk factors for death from KP. Additionally, intensive care unit (ICU) stay (OR 21.69, 95% CI 4.50–118.76, P< 0.001) and previous carbapenem exposure (OR 5.26, 95% CI 1.38–21.19, P= 0.02) are independent risk factors for CRKP. Conclusion Our findings showed that patients infected with CRKP have a higher in-hospital mortality rate. Identifying the independent risk factors for CRKP infection may contribute to the management of CRKP and reduce the mortality of KP patients.

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“…Our survey showed that twelve (63.2%) cases were dead in 19 CRKP-infected recipients. In kidney transplant recipients, the length of MV (>48h) was an independent risk factor for recipient infection death and CRKP infection ( Zhang et al., 2021 ). Some case-control studies also showed that longer MV length, longer ICU length, and elder age were independent risk factors for CRKP infection mortality ( Jiao et al., 2015 ; Akgul et al., 2016 ; Chen et al., 2022 ).…”

Section: Discussionmentioning

confidence: 99%

“…The multi-drug-resistant (MDR) bacterial pathogens emerged with the clinical application of advanced antibiotics ( Verma et al., 2022 ), such as Carbapenem-resistant Klebsiella pneumoniae (CRKP). Multiple studies have shown that the infection of MDR pathogens is the primary factor affecting the early survival rate of solid organ transplantation recipients ( Li et al., 2014 ; Zhang et al., 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Epidemic, risk factors of carbapenem-resistant Klebsiella pneumoniae infection and its effect on the early prognosis of liver transplantation

Liu

Yang²,

Dang³

et al. 2022

Front. Cell. Infect. Microbiol.

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BackgroundCarbapenem-resistant Klebsiella pneumoniae (CRKP) infection remains a major cause of morbidity and mortality in early-stage post-liver transplantation (LT).MethodsWe retrospectively analyzed the demographic and clinical infections characteristics of all LT recipients in our hospital between January 2019 and December 2021.ResultsAmong the 272 LT recipients who received LT between January 2019 and December 2021, sixty-two patients had at least one infection within 3-months post-LT, with a prevalence of 22.8% (62/272). The prevalence of CRKP infections was 7.0% (19/272), and the 3-months post-LT mortality was 19.4% (12/62). The risk factors independently related to 3-months mortality were age (Odds ratio (OR)= 1.126, 95% Confidence interval (CI): 1.009~1.257; P=0.034), mechanical ventilation (MV) (OR=1.206, 95% CI: 1.039~1.401; P =0.014), and CRKP infection (OR=18.240, 95% CI: 2.206~150.842; P =0.007). In CRKP infection, the length of ICU stay (OR=1.067, 95% CI: 1.015~1.122; P=0.011), pre-operation infection (POI) (OR=6.733, 95% CI: 1.160~39.088; P=0.034), and hepatocellular carcinoma (HCC) (OR=26.772, 95% CI: 1.747~410.187; P=0.018) were the independent risk factors. With COX multivariate regression analysis, the 3-months survival rate of CRKP infected patients was significantly lower than that without CRKP infection post-LT.ConclusionsCRKP infection is closely correlated with poor prognosis in 3-months post-LT.

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Analysis of Risk Factors for Carbapenem-Resistant Klebsiella pneumoniae Infection and Its Effect on the Outcome of Early Infection After Kidney Transplantation

Cited by 13 publications

References 27 publications

Clinical Outcomes and Microbiological Characteristics of Sequence Type 11 Klebsiella pneumoniae Infection

Clinical Outcomes and Microbiological Characteristics of Sequence Type 11 Klebsiella pneumoniae Infection

Analysis of Risk Factors and Mortality of Patients with Carbapenem-Resistant Klebsiella pneumoniae Infection

Epidemic, risk factors of carbapenem-resistant Klebsiella pneumoniae infection and its effect on the early prognosis of liver transplantation

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