Clinical and Genomic Evolution of Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infections over Two Time Periods at a Tertiary Care Hospital in South India: A Prospective Cohort Study

Abstract

Introduction:The objective of this study was to examine the evolution of carbapenem-resistant Klebsiella pneumoniae (CRKp) infections and their impact at a tertiary care hospital in South India.Methods: A comparative analysis of clinical data from two prospective cohorts of patients with CRKp bacteremia (C1, 2014-2015; C2, 2021-2022) was carried out. Antimicrobial susceptibilities and whole genome sequencing (WGS) data of selected isolates were also analyzed. Results: A total of 181 patients were enrolled in the study, 56 from C1 and 125 from C2. CRKp bacteremia shifted from critically ill patients with neutropenia to others (ICU stay: C1, 73%; C2, 54%; p = 0.02). The overall mortality rate was 50% and the introduction of ceftazidime-avibactam did not change mortality Balaji Veeraraghavan and George M. Varghese are cocorresponding authors and contributed equally to this manuscript.

Ceftazidime-avibactam alone or in combination with Aztreonam versus Polymyxins in the management of carbapenem-Resistant Klebsiella pneumoniae nosocomial Infections (CAPRI study): a retrospective cohort study from South India

“…Our results are different from a recently published study from South India that has shown no difference in mortality after introducing ceftazidime–avibactam ± aztreonam for the treatment of CRKP infections. However, it must be noted here that the study was conducted in two different timelines where improvement in supportive care could influence the results despite the adjustments [ 21 ].…”

Ceftazidime-avibactam alone or in combination with Aztreonam versus Polymyxins in the management of carbapenem-resistant Klebsiella pneumoniae nosocomial infections (CAPRI study): a retrospective cohort study from South India

“…Our results are different from a recently published study from South India that has shown no difference in mortality after introducing ceftazidime-avibactam ± aztreonam for the treatment of CRKP infections. However, it must be noted here that the study was conducted in two different timelines where improvement in supportive care could in uence the results despite the adjustments [19].…”

Gallium reactivates first and second generation quinolone antibiotics towards drug-resistant Klebsiella pneumoniae

“…5,10–13 In particular, K. pneumoniae has developed rapid resistance to carbapenems, which are highly effective beta-lactam based antibiotics which inhibit bacterial cell wall synthesis. 9,14 The development of extended spectrum beta-lactamase genes (EBSL) has also given rise to a secondary genetic and phenotypic resistance to quinolones. 5,6,14,15 Quinolone-based antibiotics target either DNA helicase or DNA topoisomerase II/IV, both of which contain peptide subunits gryA and parC.…”