Carbapenem-ResistantKlebsiella pneumoniaeInfections among ICU Admission Patients in Central China: Prevalence and Prediction Model

Abstract

Objective. To investigate the prevalence of infections due to carbapenem-resistant Klebsiella pneumoniae (CRKP) among ICU admission patients in central China and develop a reliable prediction model. Methods. Five hundred and seven consecutive ICU admission patients with Klebsiella pneumoniae (KP) infection were enrolled in this retrospective multicenter case-control study from January 2014 to June 2018. The prevalence and antimicrobial susceptibility pattern were analyzed. Multivariate analysis was performed by logistic regression modeling to determine the risk factors. A prediction model was developed and verified using data from six hospitals in central China. Results. Of the total 507 isolates of KP, 244 (48.1%) strains were carbapenem resistant. The majority of these isolates were from sputum (30.9%) and blood (20.9%) samples. Tigecycline had good activity against CRKP (95.5%). The most common sequence type (ST) of CRKP was ST11 (84.4%), and 98.6% of them had the blaKPC-2 antimicrobial resistance gene. Thirteen variables were identified as independent risk factors for CRKP infection, including KP colonization or infection in the preceding year (OR=3.32, 95% CI 2.01-4.38), CD4/CD8 ratio <1 (OR=2.98, 95% CI 2.02-4.19), and parenteral nutrition ⩾48 h (OR=1.88, 95% CI 1.22-3.04). The model developed to predict CRKP infection was effective, with an area under the receiver-operating characteristic curve of 0.854 (95% CI 0.821-0.884, p<0.001). Conclusions. ST11 carrying the blaKPC-2 antimicrobial resistance gene was the most common type of CRKP among the ICU admission patients in central China. The model demonstrated excellent predictive performance and exhibited good discrimination.

Characterization of carbapenem‐resistant Klebsiella pneumoniae in a tertiary hospital in Fuzhou, China

“…There were significant differences between regions in our study; Shanghai had the highest resistance rate (26Á9%), whereas Qinghai had the lowest (0Á3%). Our results were quite different from those of the sensitivity analysis that included 244 CRKP strains performed by Li et al (2019), who concluded that, because of its high sensitivity rate (95Á5%), tigecycline is still the best choice for CRKP. The rate of sensitivity to the remaining antibiotics was only slightly higher than 30%, except for fosfomycin, which had a sensitivity rate of 35Á2%.…”

Antimicrobial Resistance in Bacterial Pathogens and Detection of Carbapenemases in Klebsiella pneumoniae Isolates from Hospital Wastewater

“…In our study one carbapenem-resistant K. pneumoniae isolate was found resistant to tigecycline (5.3%), a glycylcycline antibiotic which is currently used as a last-line treatment in severe infections caused by multidrug-resistant Gram-positive and Gram-negative pathogens. In two previous studies tigecycline was the most appropriate therapeutic approach against infections caused by carbapenem-resistant K. pneumoniae, among intensive care unit and tertiary care center patients [55,56]. It has been reported that the combination treatment scheme of both colistin and tigecycline may act synergistically against carbapenemem-resistant infections providing low rates of mortality [57].…”

Antibiogram of Klebsiella pneumoniae isolated from various clinical samples of hospitalized patients in a tertiary care hospital of North India

“…A high levels of carbapenem resistance has also been reported in a study by Yi Liet al [17]. Since CRKP is resistant to most of the antimicrobial agents, therefore it poses a serious threat to public health [18].…”