Clinical Outcomes, Microbiological Characteristics and Risk Factors for Difficult-to-Treat Resistance to Klebsiella pneumoniae Infection

Yang, Ping; Liu, C; Wu, Zhenchao; Zheng, Jiajia; Yi, Juan; Wu, Nan; Wu, Zhangli; Lu, Ming; Cui, Liyan; Shen, Ning

doi:10.2147/idr.s377064

Cited by 5 publications

(6 citation statements)

References 35 publications

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“…This delay poses a challenge for gynecologists to reduce the risk of adverse maternal sepsis outcomes. These ndings are similar to those of previous studies [3,5,11,22,30,34,37,38,40].…”

Section: Treatment and Management Of Maternal Sepsissupporting

confidence: 93%

“…Many studies have shown that various contributing factors include a medical history of chronic diseases such as gestational hypertension, diabetes, cancer, hospitalization, ventilator use, catheterization, kidney or lung disease, preeclampsia, abortion, and a history of antibiotic use during gestation [29]. Habits, such as smoking, alcoholism, and drug abuse, can also play a role in the development of these bacterial infections [30]. Educational level and intravenous drug administration can also be contributing factors [28,30].…”

Section: Introductionmentioning

confidence: 99%

“…Habits, such as smoking, alcoholism, and drug abuse, can also play a role in the development of these bacterial infections [30]. Educational level and intravenous drug administration can also be contributing factors [28,30]. Additionally, when maternal sepsis patients arrive at tertiary hospitals, they are given immediately antibiotics such as trimethoprim-sulfamethoxazole, ampicillin, cipro oxacin, cefepime, aztreonam, ceftriaxone, amoxicillin, gentamicin, clindamycin, vancomycin, piperacillintazobactam, and tigecycline.…”

Section: Introductionmentioning

confidence: 99%

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Epidemiology, antimicrobial resistance profile and management of Carbapenem-resistant Klebsiella pneumoniae among mothers with suspected sepsis in Ethiopia

Gadisa

2024

Clinica Chimica Acta

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“…This delay poses a challenge for gynecologists to reduce the risk of adverse maternal sepsis outcomes. These ndings are similar to those of previous studies [3,5,11,22,30,34,37,38,40].…”

Section: Treatment and Management Of Maternal Sepsissupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Epidemiology, antimicrobial resistance profile and management of Carbapenem-resistant Klebsiella pneumoniae among mothers with suspected sepsis in Ethiopia

Gadisa

2024

Clinica Chimica Acta

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“…Even more worrisome is the continuing occurrence of multidrug resistant and hypervirulent Kp (MDR-hvKp) worldwide, which is virtually impossible to treat, increasing the burden on public health [ 1 , 8 – 10 ]. Previous studies reported that the acquisition of virulence-associated genes within cKp and acquisition of MDR plasmids by HvKp primarily contributed to MDR-hvKp, especially in China [ 7 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

ST218 Klebsiella pneumoniae became a high-risk clone for multidrug resistance and hypervirulence

Yang,

Liu,

et al. 2024

BMC Microbiol

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Background The occurrence of multidrug-resistant and hypervirulent Klebsiella pneumoniae (MDR-hvKp) worldwide poses a great challenge for public health. Few studies have focused on ST218 MDR-hvKp. Methods Retrospective genomic surveillance was conducted at the Peking University Third Hospital from 2017 and clinical information was obtained. To understand genomic and microbiological characteristics, antimicrobial susceptibility testing, plasmid conjugation and stability, biofilm formation, serum killing, growth curves and whole-genome sequencing were performed. We also assessed the clinical and microbiological characteristics of ST218 compared with ST23. Results A total of eleven ST218 Kp isolates were included. The most common infection type was lower respiratory tract infection (72.7%, 8/11) in our hospital, whereas ST23 hvKp (72.7%, 8/11) was closely associated with bloodstream infection. Notably, nosocomial infections caused by ST218 (54.5%, 6/11) was slightly higher than ST23 (36.4%, 4/11). All of the ST218 and ST23 strains presented with the virulence genes combination of iucA + iroB + peg344 + rmpA + rmpA2. Interestingly, the virulence score of ST218 was lower than ST23, whereas one ST218 strain (pPEKP3107) exhibited resistance to carbapenems, cephalosporins, β-lactamase/inhibitors and quinolones and harbored an ~ 59-kb IncN type MDR plasmid carrying resistance genes including blaNDM-1, dfrA14 and qnrS1. Importantly, blaNDM-1 and qnrS1 were flanked with IS26 located within the plasmid that could successfully transfer into E. coli J53. Additionally, PEKP2044 harbored an ~ 41-kb resistance plasmid located within tetA indicating resistance to doxycycline. Conclusion The emergence of blaNDM-1 revealed that there is great potential for ST218 Kp to become a high-risk clone for MDR-hvKp, indicating the urgent need for enhanced genomic surveillance.

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“…Li G et al reported that Galleria mellonella killing assay in conjugation with the string test could be used to accurately assess KP virulence and differentiate hvKP from cKP strains [ 7 ]. Russo TA et al noted that peg-344 , iroB, iucA , prmpA , prmpA2 , and siderophore production greater than 30 μg/ml could accurately identify hvKP strains [ 1 , 8 , 9 ]. However, there is no universal standard for identifying all hvKP strains [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Prognostic models for estimating severity of disease and predicting 30-day mortality of Hypervirulent Klebsiella pneumoniae infections: a bicentric retrospective study

Huang,

Chen,

et al. 2023

BMC Infect Dis

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Background Hypervirulent Klebsiella pneumoniae (hvKP) is emerging globally and can cause various, severe infections in healthy individuals. However, the clinical manifestations of hvKP infections are nonspecific, and there is no gold standard for differentiating hvKP strains. Our objective was to develop prognostic models for estimating severity of disease and predicting 30-day all-cause mortality in patients with hvKP infections. Methods We enrolled 116 patients diagnosed with hvKP infections and obtained their demographic and clinical data. Taking septic shock and acute respiratory distress syndrome (ARDS) as the primary outcomes for disease severity and 30-day all-cause mortality as the primary outcome for clinical prognosis, we explored the influencing factors and constructed prognostic models. Results The results showed that increased Acute Physiologic and Chronic Health Evaluation (APACHE) II score [odds ratio (OR) = 1.146; 95% confidence interval (CI), 1.059–1.240], decreased albumin (ALB) level (OR = 0.867; 95% CI, 0.758–0.990), diabetes (OR = 9.591; 95% CI, 1.766–52.075) and high procalcitonin (PCT) level (OR = 1.051; 95%CI, 1.005–1.099) were independent risk factors for septic shock. And increased APACHE II score (OR = 1.254; 95% CI, 1.110–1.147), community-acquired pneumonia (CAP) (OR = 11.880; 95% CI, 2.524–55.923), and extrahepatic lesion involved (OR = 14.718; 95% CI, 1.005–215.502) were independent risk factors for ARDS. Prognostic models were constructed for disease severity with these independent risk factors, and the models were significantly correlated with continuous renal replacement therapy (CRRT) duration, vasopressor duration, mechanical ventilator duration and length of ICU stay. The 30-day all-cause mortality rate in our study was 28.4%. Younger age [hazard ratio (HR) = 0.947; 95% CI, 0.923–0.973)], increased APACHE II score (HR = 1.157; 95% CI, 1.110–1.207), and decreased ALB level (HR = 0.924; 95% CI, 0.869–0.983) were the independent risk factors for 30-day all-cause mortality. A prediction model for 30-day mortality was constructed, which had a good validation effect. Conclusions We developed validated models containing routine clinical parameters for estimating disease severity and predicting 30-day mortality in patients with hvKP infections and confirmed their calibration. The models may assist clinicians in assessing disease severity and estimating the 30-day mortality early.

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Clinical Outcomes, Microbiological Characteristics and Risk Factors for Difficult-to-Treat Resistance to Klebsiella pneumoniae Infection

Cited by 5 publications

References 35 publications

Epidemiology, antimicrobial resistance profile and management of Carbapenem-resistant Klebsiella pneumoniae among mothers with suspected sepsis in Ethiopia

Epidemiology, antimicrobial resistance profile and management of Carbapenem-resistant Klebsiella pneumoniae among mothers with suspected sepsis in Ethiopia

ST218 Klebsiella pneumoniae became a high-risk clone for multidrug resistance and hypervirulence

Prognostic models for estimating severity of disease and predicting 30-day mortality of Hypervirulent Klebsiella pneumoniae infections: a bicentric retrospective study

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