Changes of Klebsiella pneumoniae infection and carbapenem resistance in ICU elderly infected patients before and after the COVID-19 pandemic in Zhengzhou, China

Ding, Xianfei; Liang, Huoyan; Qi, Xueyan; Sun, Guiying; Cheng, Ming; Feng, Min; Sun, Tongwen

doi:10.1016/j.jinf.2023.01.008

Cited by 3 publications

(2 citation statements)

References 10 publications

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“…The lack of effective treatments for infections involving multidrug-resistant Klebsiella pneumoniae infections may result in higher risks of mortality and disease burden, which merits attention. Our results showed that after the outbreak of the pandemic, the risk of CR-kpn decreased significantly, which was consistent with recent research ( 39 , 40 ). There were also increasing cases of carbapenems-resistant Enterobacter after the COVID-19 outbreak ( 41–44 ).…”

Section: Discussionsupporting

confidence: 93%

Multiple impacts of the COVID-19 pandemic and antimicrobial stewardship on antimicrobial resistance in nosocomial infections: an interrupted time series analysis

Li,

Yang,

Liu

et al. 2024

Front. Public Health

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ObjectivesThe emergency response to the COVID-19 pandemic may disrupt hospital management activities of antimicrobial resistance (AMR). This study aimed to determine the changing AMR trend over the period in China when stringent COVID-19 response measures were implemented.MethodsThis retrospective study was conducted in a designated hospital for COVID-19 patients in Guangzhou, China from April 2018 to September 2021. The prevalence of 13 antimicrobial-resistant bacteria was compared before and after the COVID-19 responses through Chi-square tests. Interrupted time series (ITS) models on the weekly prevalence of AMR were established to determine the changing trend. Controlled ITS models were performed to compare the differences between subgroups.ResultsA total of 10,134 isolates over 1,265 days were collected. And antimicrobial-resistant strains presented in 38.6% of the testing isolates. The weekly AMR prevalence decreased by 0.29 percentage point (95% CI [0.05–0.80]) after antimicrobial stewardship (AMS) policy, despite an increase in the prevalence of penicillin-resistant Streptococcus pneumoniae (from 0/43 to 15/43, p < 0.001), carbapenem-resistant Escherichia coli (from 20/1254 to 41/1184, p = 0.005), and carbapenem-resistant Klebsiella pneumoniae (from 93/889 to 114/828, p = 0.042). And the changing trend did not vary by gender (male vs. female), age (<65 vs. ≥65 years), service setting (outpatient vs. inpatient), care unit (ICU vs. non-ICU), the primary site of infection (Lung vs. others), and Gram type of bacteria (positive vs. negative).ConclusionThe response to COVID-19 did not lead to an increase in overall AMR; however, it appears that management strategy on the prudent use of antimicrobials likely contributed to a sizable long-term drop. The frequency of several multidrug-resistant bacteria continues to increase after the COVID-19 epidemic. It is crucial to continue to monitor AMR when COVID-19 cases have surged in China after the relaxation of restriction measures.

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Section: Discussionsupporting

confidence: 93%

Multiple impacts of the COVID-19 pandemic and antimicrobial stewardship on antimicrobial resistance in nosocomial infections: an interrupted time series analysis

Li,

Yang,

Liu

et al. 2024

Front. Public Health

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“…Surveillance data have shown that the prevalence of CRKP among patients admitted to the intensive care unit (ICU) ranges from 20.8% to 48.1%, which is notably higher than that observed in other clinical departments ( 11 , 12 ). Additionally, it is important to note that the mortality rates of patients infected with CRKP in the ICU are significantly higher compared to those in non-ICU settings ( 13 ). Numerous studies have investigated the risk factors associated with CRKP infection in patients admitted to the ICU, resulting in the development of various risk prediction models ( 14 – 17 ).…”

Section: Introductionmentioning

confidence: 99%

Development and application of a nomogram model for the prediction of carbapenem-resistant Klebsiella pneumoniae infection in neuro-ICU patients

Lu,

Zhang,

Shi

et al. 2024

Microbiol Spectr

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This study aimed to develop and validate a simple-to-use nomogram model to assess the risk of infection caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) in neurocritically ill patients. The clinical data of 544 patients with CRKP infection admitted to a neurointensive care unit (neuro-ICU) were retrospectively analyzed. The demographic data, laboratory test results, and clinical characteristics of patients in the neuro-ICU were collected. Subsequently, multivariate regression analysis was used to construct a nomogram to predict the risk of CRKP infection in these patients. The calibration ability, clinical effectiveness, and discriminative ability of the nomogram were evaluated. The incidence of CRKP infection was estimated to be 6.43%, and a majority of bacterial isolates causing the infection were found in sputum (74.3%). Multivariate regression analysis showed that the number of antibiotics of ≥2 [odds ratio (OR): 9.08, 95% confidence interval (CI): 2.78–29.71], undergoing surgery (OR: 3.84, 95% CI: 1.09–13.54), and long neuro-ICU stay (OR: 1.08, 95% CI: 1.01–1.14) were associated with CRKP infection in neurocritically ill patients. The nomogram model demonstrated good calibration and discrimination in both the training and validation sets, with area under the curve values of 0.860 and 0.907, respectively. This study developed and validated a nomogram that combines three easily accessed variables during clinical practice to predict the risk of nosocomial CRKP infection in neuro-ICU patients. The tool demonstrated a good predictive performance and discrimination, which might serve as a useful tool to facilitate early detection and reduction of the CRKP infection risk in neurocritically ill patients. IMPORTANCE Patients in neuro-ICU are at a high risk of developing nosocomial CRKP infection owing to complex conditions, critical illness, and frequent invasive procedures. However, studies focused on constructing prediction models for assessing the risk of CRKP infection in neurocritically ill patients are lacking at present. Therefore, this study aims to establish a simple-to-use nomogram for predicting the risk of CRKP infection in patients admitted to the neuro-ICU. Three easily accessed variables were included in the model, including the number of antibiotics used, surgery, and the length of neuro-ICU stay. This nomogram might serve as a useful tool to facilitate early detection and reduction of the CRKP infection risk of neurocritically ill patients.

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An increased prevalence of carbapenem-resistant hypervirulent Klebsiella pneumoniae associated with the COVID-19 pandemic

Liu,

Guo,

Fan

et al. 2024

Drug Resistance Updates

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Changes of Klebsiella pneumoniae infection and carbapenem resistance in ICU elderly infected patients before and after the COVID-19 pandemic in Zhengzhou, China

Cited by 3 publications

References 10 publications

Multiple impacts of the COVID-19 pandemic and antimicrobial stewardship on antimicrobial resistance in nosocomial infections: an interrupted time series analysis

Multiple impacts of the COVID-19 pandemic and antimicrobial stewardship on antimicrobial resistance in nosocomial infections: an interrupted time series analysis

Development and application of a nomogram model for the prediction of carbapenem-resistant Klebsiella pneumoniae infection in neuro-ICU patients

An increased prevalence of carbapenem-resistant hypervirulent Klebsiella pneumoniae associated with the COVID-19 pandemic

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