Clinical Observation and Prognostic Analysis of Patients With Klebsiella pneumoniae Bloodstream Infection

Zhang, Shuguang; Yang, Zeliang; Wang, Zhenhua; Sun, Liutao; Xu, Jun‐Fa; Zeng, Li; Sun, Tongwen

doi:10.3389/fcimb.2020.577244

Cited by 20 publications

(15 citation statements)

References 40 publications

(48 reference statements)

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“…Today, according to the BIGSDB Institute Pasteur database ( access date 8 August 2021), 5797 K. pneumoniae sequence types and 711 capsular types have been discovered. K. pneumoniae causes different infections in ICU patients associated with high mortality rates, including bloodstream infection, pulmonary infection, and healthcare-associated ventriculitis, meningitis, and urinary tract infection [ 2 , 3 ]. It was reported from China, Spain, and Taiwan that K. pneumoniae was associated with leukocytoclastic vasculitis and microcirculation disorders, but there is no data on the relationship of such a clinical manifestation with any K. pneumoniae genetic lineages [ 4 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Multidrug-Resistant Klebsiella pneumoniae Causing Severe Infections in the Neuro-ICU

et al. 2021

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The purpose of this study was the identification of genetic lineages and antimicrobial resistance (AMR) and virulence genes in Klebsiella pneumoniae isolates associated with severe infections in the neuro-ICU. Susceptibility to antimicrobials was determined using the Vitek-2 instrument. AMR and virulence genes, sequence types (STs), and capsular types were identified by PCR. Whole-genome sequencing was conducted on the Illumina MiSeq platform. It was shown that K. pneumoniae isolates of ST14K2, ST23K57, ST39K23, ST76K23, ST86K2, ST218K57, ST219KL125/114, ST268K20, and ST2674K47 caused severe systemic infections, including ST14K2, ST39K23, and ST268K20 that were associated with fatal incomes. Moreover, eight isolates of ST395K2 and ST307KL102/149/155 were associated with manifestations of vasculitis and microcirculation disorders. Another 12 K. pneumoniae isolates of ST395K2,KL39, ST307KL102/149/155, and ST147K14/64 were collected from patients without severe systemic infections. Major isolates (n = 38) were XDR and MDR. Beta-lactamase genes were identified: blaSHV (n = 41), blaCTX-M (n = 28), blaTEM (n = 21), blaOXA-48 (n = 21), blaNDM (n = 1), and blaKPC (n = 1). The prevalent virulence genes were wabG (n = 41), fimH (n = 41), allS (n = 41), and uge (n = 34), and rarer, detected only in the genomes of the isolates causing severe systemic infections—rmpA (n = 8), kfu (n = 6), iroN (n = 5), and iroD (n = 5) indicating high potential of the isolates for hypervirulence.

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Section: Introductionmentioning

confidence: 99%

Multidrug-Resistant Klebsiella pneumoniae Causing Severe Infections in the Neuro-ICU

et al. 2021

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“…The results of our multivariate analysis suggest that the risk factors for 28-day mortality after a hospital-acquired KP BSI were CRKP BSI, septic shock, mechanical ventilation >96 hours, and platelet counts <100×10 9 /L, similar results have been reported in previous studies. 67 , 68 Our univariate analysis suggested that a high coefficient of variation of red blood cell distribution width (RDW-CV) was a risk factor for the 28-day mortality of KP BSI patients. Red blood cell distribution width (RDW) has been recently found to be a potential marker of cardiovascular disease.…”

Section: Discussionmentioning

confidence: 89%

Risk Factors for a Hospital-Acquired Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infection: A Five-Year Retrospective Study

Cao¹,

Yue²,

Kong³

et al. 2022

IDR

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Purpose This study aimed to describe trends in Klebsiella pneumoniae (KP) resistance in bloodstream infections (BSI) and to identify risk factors for a hospital-acquired carbapenem-resistant Klebsiella pneumoniae (CRKP) BSI and 28-day mortality from a hospital-acquired KP BSI. Patients and Methods We recorded the results of antimicrobial susceptibility testing of 396 KP-positive blood cultures from January 2016 to December 2020. A total of 277 patients with a KP BSI were included in this study, of which 171 had a hospital-acquired infection and 84 had a hospital-acquired CRKP BSI. Multivariate logistic regression analysis was used to identify risk factors for a hospital-acquired CRKP BSI and 28-day mortality from a hospital-acquired KP BSI. Results The proportion of hospital-acquired infections among KP BSI patients increased from 53.1% in 2016 to 72.8% in 2020. The detection rate of CRKP among KP BSI patients increased from 18.8% in 2016 to 37.7% in 2020. Multivariate logistic regression showed that β-lactam/β-lactamase inhibitor combinations (BLBLIs) exposure ( P = 0.022, OR 2.863), carbapenems exposure ( P = 0.007, OR 3.831) and solid organ transplantation ( P <0.001, OR 19.454) were independent risk factors for a hospital-acquired CRKP BSI. Risk factors for a 28-day mortality from hospital-acquired KP BSI were CRKP BSI ( P =0.009, OR 5.562), septic shock ( P =0.002, OR 4.862), mechanical ventilation>96 hours ( P =0.020, OR 8.765), and platelet counts <100×10 9 /L ( P =0.003, OR 4.464). Conclusion The incidence of hospital-acquired KP BSI continues to rise and the proportion of CRKP BSI is also increasing. We believe that the use of the BLBLIs needs to be carefully evaluated in hospital-acquired infection. Hospital-acquired KP BSI Patients with CRKP BSI, septic shock, mechanical ventilation and deficiency of platelets are more likely to have a poor prognosis.

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“…The remainder included multiple species of Gram-negative bacilli [15, 17-20, 22, 24, 26, 27, 29, 30, 33, 39, 48, 50, 53, 54, 59, 60]. Among eight studies all the participants were admitted to ICU [22,23,46,48,51,52,59,62].…”

Section: Resultsmentioning

confidence: 99%

Antibiotic combination therapy versus monotherapy for the treatment of infections due to carbapenem-resistant Gram-negative bacteria： a systematic review and meta-analysis

Lai

Zhang

et al. 2022

Preprint

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Background: Increasing evidence has suggested that combination antibiotic therapy is more effective than monotherapy and leads to better outcomes.However, results from observational researches were contradictory and did not support the combination antibiotic therapy in this context. Here, a meta-analysis of published studies determined whether a combination of two or more antimicrobial agents reduces mortality in patients with Gram-negative bacteremia. Objective: The aim of the review was to comprehensively summarize the evidence and evaluate the impact of antibiotic combinations or monotherapy on infection caused by carbapenem-resistant Gram-negative bacteria. Method: A comprehensive computerized search was performed through PubMed, Cochrane library, web of science and Embase up to March 15, 2012, to identify published studies. We would include randomized controlled trials, non-randomised studies without consideration of publication status, time of publication, blinding status or language. Case reports, review articles were excluded. Studies were considered available if they compared monotherapy regimens with combination therapy regimens for treating infection due to carbapenem-resistant Gram-negative bacteria. Results: A total of 52 studies were included enrolling 6524 participants, which included 5 randomized controlled trials and 47 non-randomised studies of the effects of interventions. The results showed higher mortality (OR=1.38, 95%CI=1.17-1.64) in monotherapy groups, lower clinical success (OR=0.63, 95%CI=0.45-0.89) and microbiological eradication (OR=0.60, 95%CI=0.43-0.84) in monotherapy for treating carbapenem-resistant Gram-negative bacteremia. Similarly, significant higher mortality (OR=1.58, 95%CI=1.22-2.06), lower clinical success (OR=0.36, 95%CI=0.24-0.53) and microbiological eradication (OR=0.36, 95%CI=0.18-0.72) in monotherapy for treating carbapenem-resistant Enterobacteriaceae. There were only few clinical researches comparing the effect of combination therapy versus monotherapy, most of them being case-control and retrospective cohort studies limited by small study size. Well- argued randomised controlled trials are lacking. Conclusions: Infection patients caused by carbapenem-resistant Gram-negative bacteria may benefit from combination therapy. We suggest choosing combination therapy to treat severe infection due to carbapenem-resistant Gram-negative bacteria before larger and better-devised randomized controlled trials completed. Because of risk and the design of the available studies, well-powered randomized controlled trials are needed.

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Clinical Observation and Prognostic Analysis of Patients With Klebsiella pneumoniae Bloodstream Infection

Cited by 20 publications

References 40 publications

Multidrug-Resistant Klebsiella pneumoniae Causing Severe Infections in the Neuro-ICU

Multidrug-Resistant Klebsiella pneumoniae Causing Severe Infections in the Neuro-ICU

Risk Factors for a Hospital-Acquired Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infection: A Five-Year Retrospective Study

Antibiotic combination therapy versus monotherapy for the treatment of infections due to carbapenem-resistant Gram-negative bacteria： a systematic review and meta-analysis

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