Characteristics and outcomes of<i>Klebsiella pneumoniae</i>bacteraemia in Hong Kong

Pau, Carrie K. Y.; Ma, Florence F. T.; Ip, Margaret; You, Joyce H. S.

doi:10.3109/00365548.2014.985710

Cited by 21 publications

(19 citation statements)

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“…Studies reported from USA, Italy, Hong Kong and Korea also include data supporting our results (Pau et al 2015; Kang et al 2006; Capone et al 2013; Qureshi et al 2012). Qureshi et al have assumed that high mortality in BSI secondary to pneumonia was due to the higher severity of underlying disease and relative difficulty in controlling the source of infection in pneumonia compared with other sources (Qureshi et al 2012).…”

Section: Discussionsupporting

confidence: 90%

“…Presence of many adverse factors such as co-morbid diseases or negative clinical conditions adversely effecting survival may cancel the positive effects of appropriate use of empirical antibiotic therapy in lowering mortality rates. In similar studies it was reported that conformity of initial therapy with antibiogram test doesn’t lead to a change in survival rate of patients (Ben-David et al 2012; Pau et al 2015; Correa et al 2013; Qureshi et al 2012). …”

Section: Discussionmentioning

confidence: 92%

“…Enterobacteriaceae are among the most important HAI source (Tumbarello et al 2012). Within enterobacteriaceae family K. pneumoniae is the most common microorganism isolated as a source of infection in HAI (Tumbarello et al 2012; Ben-David et al 2012; Pau et al 2015; Vardakas et al 2015). …”

Section: Introductionmentioning

confidence: 99%

“…Behindhand discovery of novel effective antibiotics relative to increasing bacterial resistance rates pose difficulty in treating infections and increases mortality rates (Chen et al 2012). In studies investigating NKp BSI outcomes crude mortality rate was reported at a high range between 23 and 69% (Kontopidou et al 2014; Tumbarello et al 2012; Ben-David et al 2012; Pau et al 2015; Vardakas et al 2015; van Duin et al 2014; Hoxha et al 2016; Ulu et al 2015; Kang et al 2006; Daikos et al 2014; Correa et al 2013). Structure of nosocomial infections is dynamic and complex and usually includes multiple variables negatively effecting clinical outcome.…”

Section: Introductionmentioning

confidence: 99%

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Mortality markers in nosocomial Klebsiella pneumoniae bloodstream infection

et al. 2016

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Purpose Klebsiella pneumoniae is the most common endogen agent for nosocomial infections. In this study, mortality markers were investigated in patients with nosocomial K. pneumoniae blood stream infection (NKp BSI).MethodsThe characteristics of patients >16 years who had NKp BSI diagnosis by daily active surveillance between January 2012 and January 2016 were retrospectively evaluated. Patients who died until 28th day of the clinical follow up and those who survived until this time were statistically compared in terms of various risk factors.ResultsOne hundred ninety patients were included into the study. Mortality rate was 47.9%, carbapenem resistance was 43.2%. Statistical analysis have shown that in presence of post-NKp BSI sepsis, septic shock, following in intensive care unit (ICU), meropenem resistance, kidney failure, NKp BSI secondary to pneumonia, use of invasive instruments such as central venous catheter (CVC), urinary catheter (UC) and mechanical ventilator (MV), colostomy, transfusion and hemodialysis mortality was significantly higher. In patients admitted into the hospital for neurological disorders, pancreaticobiliary tract (PBT) diseases and patients who have undergone endoscopic retrograde cholangiopancreatography (ERCP) and patients in whom NKp BSI secondary to PBT infection mortality rate was lower.ConclusionsSepsis, septic shock, clinical conditions requiring ICU treatment and meropenem resistance increase mortality rates in NKp BSI significantly. Mortality was higher also in patients with NKp BSI secondary to pneumonia, in kidney failure and when invasive instruments were used. On the other hand, in patients who were admitted to the hospital for neurological disorders and PBT diseases mortality rate was lower.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mortality markers in nosocomial Klebsiella pneumoniae bloodstream infection

et al. 2016

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“…After adjusting for multiple confounders, several parameters, such as probable source of infection from lung and high SOFA score, were associated with a higher crude 28-day mortality, as previously described [9, 41, 42]. For patients with SOFA scores above 7 at the onset of bacteremia, the 14-day mortality rate was shown to increase [43].…”

Section: Discussionmentioning

confidence: 68%

Epidemiology of Klebsiella pneumoniae bloodstream infections in a teaching hospital: factors related to the carbapenem resistance and patient mortality

Tian

Tan

Yang

et al. 2016

Antimicrob Resist Infect Control

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BackgroundAlthough Klebsiella pneumoniae bloodstream infections (KP-BSIs) have recently attracted attention due to an alarming raise in morbidity and mortality, there have been few reports on the epidemiology of KP-BSIs in mainland China. We sought to describe the epidemiological, microbiological, and clinical characteristics of KP-BSIs, focusing on the risk factors of carbapenem resistance and patient mortality.MethodsA retrospective analysis of WHONET data of KP-BSI patients admitted to a teaching hospital in Shanghai, China, between January 1, 2011 and December 31, 2015 was performed, and the annual percentage of patients with carbapenem-resistant K. pneumoniae (CRKP) was determined. Risk factors related to the carbapenem resistance and patient mortality were analyzed using binary logistic regression model. The genetic relatedness of CRKP strains isolated from intensive care unit (ICU) patients was determined by pulsed-field gel electrophoresis (PFGE).ResultsA total of 293 incidences of KP-BSIs were identified in a 5-year period, 22.18% of these (65/293) were CRKP strains, and the proportion of CRKP-BSI in ICU was 59.62% (31/52), equaling the levels observed in the epidemic regions. A number of KP-BSIs (114), obtained from January 1, 2014, to December 31, 2015, were further investigated. Skin and soft tissue infection source (odds ratio [OR] 26.63, 95% confidence interval [CI] 4.8–146.8) and ICU-acquired infection (OR 5.82, 95% CI 2.0–17.2) was shown to be powerful risk factors leading to the development of CRKP-BSI. The crude 28-day mortality rates of KP-BSI and CRKP-BSI patients were 22.8% and 33.3%, respectively. Lung as the probable source of infection (OR 4.23, 95% CI 1.0–17.3), and high Sequential Organ Failure Assessment (SOFA) score (OR 1.40, 95% CI 1.2–1.6) were strong prognostic factors determining crude 28-day KP-BSI mortality rates. PFGE analysis demonstrated that 10/11 random CRKP isolates in ICU belonged to the same clonal type.ConclusionsDuring the study period, we observed a significant increase in the occurrence of CRKP infections among the identified KP-BSIs in our hospital and especially in ICU, and we demonstrated that carbapenem resistance is associated with the increased mortality of KP-BSI patients.

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Activity of temocillin and 15 other agents, including fosfomycin and colistin, against Enterobacteriaceae in Hong Kong

Lai

Fung

et al. 2017

Eur J Clin Microbiol Infect Dis

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Limited data are available on temocillin susceptibilities in Enterobacteriaceae from Asian countries where antimicrobial resistance is prevalent. The in vitro activities of temocillin and 15 commonly used antimicrobials against 613 non-duplicate blood (n = 310) and urine (with clinically significant bacteriuria; n = 303) isolates of Enterobacteriaceae from patients who attended 3 out of 7 clusters of public hospitals of the Hospital Authority, Hong Kong, during 2015/2016 were tested. Minimum inhibitory concentrations (MICs) were determined by Clinical and Laboratory Standards Institute (CLSI) microbroth dilution (agar dilution with fosfomycin). For temocillin, MICs were also obtained using the British Society of Antimicrobial Chemotherapy (BSAC) microbroth dilution method and interpreted using the BSAC breakpoints. Overall, 93.0% (570) isolates were susceptible to temocillin using BSAC systemic breakpoint (≤8 mg/L) and all except 2 isolates were susceptible using the urinary breakpoint (≤32 mg/L). The extended spectrum beta-lactamase (ESBL) positivity rate was 23.2% (118 out of 508 E. coli, Klebsiella spp., Proteus spp.). Temocillin resistance rate to ESBL-positive isolates was 16.1% using the systemic breakpoint of ≤8 mg/L (MIC50 and MIC90 were 8 mg/L and 16 mg/L respectively). Two isolates (1 E. coli, temocillin MIC 64 mg/L, 1 Klebsiella sp., MIC 32 mg/mL) were resistant to meropenem and possessed the NDM-5 and KPC-2 genes respectively. Other susceptibility rates were: amoxicillin/clavulanate (59.1%), trimethoprim/sulfamethoxazole (62.5%), ciprofloxacin (71.5%), ceftriaxone (75.4%), nitrofurantoin (76.4%), gentamicin (78.3%), cefepime (81.1%), ceftazidime (83.5%), piperacillin/tazobactam (86%), colistin (88.8%), tigecycline (89.4%), fosfomycin (92.8%), ertapenem (99.0%), amikacin (99.2%) and meropenem (99.7%). Temocillin may be a useful alternative for the treatment of infections caused by ESBL and multi-drug-resistant Enterobacteriaceae in Hong Kong, particularly as resistance rates to ciprofloxacin, nitrofurantoin and piperacillin/tazobactam are high.Electronic supplementary materialThe online version of this article (10.1007/s10096-017-3091-8) contains supplementary material, which is available to authorized users

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Characteristics and outcomes ofKlebsiella pneumoniaebacteraemia in Hong Kong

Abstract: The 30-day mortality and treatment cost of patients with K. pneumoniae bacteraemia were high in Hong Kong. Based upon the risk factors identified, infection control and treatment algorithms for K. pneumoniae bacteraemia in patients with malignancy or liver disease are highly warranted.

Cited by 21 publications

References 21 publications

Mortality markers in nosocomial Klebsiella pneumoniae bloodstream infection

Mortality markers in nosocomial Klebsiella pneumoniae bloodstream infection

Epidemiology of Klebsiella pneumoniae bloodstream infections in a teaching hospital: factors related to the carbapenem resistance and patient mortality

Activity of temocillin and 15 other agents, including fosfomycin and colistin, against Enterobacteriaceae in Hong Kong

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