Dissemination of extensively drug-resistant and KPC-2 producing Klebsiella pneumoniae isolated from bloodstream infections

Zhao, Feng; Zhang, Jun; Fu, Ying; Ruan, Zhi; Xie, Xinyou

doi:10.3855/jidc.6679

Cited by 12 publications

(9 citation statements)

References 14 publications

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“…The crude 28-day mortality in KP-BSI patients was shown to be 22.8%, which increased to 33.3% in CRKP-BSI patients, similar to the rates obtained in both Chinese and foreign studies [12, 25, 29, 36–38]. Furthermore, the mortality of CRKP-BSI patients was shown to be higher than that of CSKP-BSI patients, which may be a consequence of the infection with ST11 clone, which is a dominant CRKP strain in China [28] with an increased pathogenic potential and resistance to serum killing [39, 40].…”

Section: Discussionsupporting

confidence: 86%

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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Section: Discussionsupporting

confidence: 86%

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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“…Moreover, most of our carbapenems resistant K pneumoniae strains were recovered from ICU that may be referred to the critical illness of most of ICU patients. They may be transferred back to other wards leading to transmission of MDR strains to other patients, so antimicrobial resistance testing should be a part of routine treatment protocols of critically ill patients to prevent spread of resistance genes . Carbapenemase enzymes have a broad‐spectrum effect, so phenotypic methods cannot specifically identify a carbapenemase enzyme or its specific gene .…”

Section: Discussionmentioning

confidence: 99%

Multidrug‐resistant Klebsiella pneumoniae in hospital‐acquired infections: Concomitant analysis of antimicrobial resistant strains

et al. 2019

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Background Hospital‐acquired infections caused by K pneumoniae are difficult to eradicate since K pneumoniae carries resistance genes for many antimicrobials, including carbapenems. The study aimed to determine the prevalence of hospital‐acquired infections caused by multiple drug‐resistant K pneumoniae and identify carbapenem and fluoroquinolone resistance by phenotypic and genotypic methods amongst hospitalised patients. Methods Two hundred and fifty samples from patients with hospital‐acquired infections were included. Identification and susceptibility testing for K pneumoniae isolates was performed by standard methods. The detection of carbapenemase resistance (blaKPC, blaVIM‐1 and blaOXA‐48) and plasmid‐mediated quinolone resistance (PMQR; qnrA, qnrB and qnrS) genes was performed using PCR assay. Results Out of 250 samples, 42 (16.8%) were multiple drug‐resistant K pneumoniae, and the frequency of K Pneumoniae isolation was higher in urine samples, in the age group (<10 years), in ICU and in patients with longer hospital stay. Twenty‐four (57%) of the isolates were resistant to Meropenem, 13 (31%) were resistant to Imipenem and 35 (83.3%) were resistant to Ciprofloxacin. blaOXA‐48 gene was detected in 9 (21.4%) of isolates, and blaVIM‐1 gene was detected in 6 (14.3%) of isolates. However, no isolate harboured blaKPC gene. PMQR genes were detected in 100% of ciprofloxacin resistant isolates, and qnrS was the dominant. Conclusion Multidrug‐resistant K pneumoniae isolates harbouring blaOXA‐48, blaVIM‐1 and PMQR genes are emerging in hospitals particularly with long hospital stays.

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“…It is a growing global reality, that XDR K. pneumoniae nosocomial infections are associated with delays in appropriate therapy, and therefore pose serious challenges to clinically effective therapeutic options worldwide (Lim et al, 2015). The increasing prevalence and global dissemination of these clinical XDR strains gravely threatens public health (Zhao et al, 2015). …”

Section: Discussionmentioning

confidence: 99%

Extensively Drug-Resistant Klebsiella pneumoniae Causing Nosocomial Bloodstream Infections in China: Molecular Investigation of Antibiotic Resistance Determinants, Informing Therapy, and Clinical Outcomes

Liu

Dunstan

et al. 2017

Front. Microbiol.

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The rise in diversity of antimicrobial resistance phenotypes seen in Klebsiella pneumoniae is becoming a serious antibiotic management problem. We sought to investigate the molecular characteristics and clinical implications of extensively drug-resistant (XDR) K. pneumoniae isolated from different nosocomial bloodstream infections (BSIs) patients from July 2013 to November 2015. Even in combination treatment, meropenem did not protect against mortality of BSIs patients (P = 0.015). In contrast, tigecycline in combination with other antimicrobial agents significantly protected against mortality (P = 0.016). Antimicrobial susceptibility tests, molecular detection of antibiotic resistance determinants, conjugation experiments, multilocus sequence typing (MLST), S1-PFGE, Southern blot, SDS-PAGE, immunoblot analysis, and pulsed-field gel electrophoresis (PFGE) were used to characterize these isolates. These XDR K. pneumoniae strains were resistant to conventional antimicrobials except tigecycline and polymyxin B and co-harbored diverse resistance determinants. rmtB, blaKPC−2 as well as blaCTX−M−9 were located on a transferable plasmid of ~54.2 kb and the most predominant replicon type was IncF. 23 of the 35 isolates belonging the predominant clone were found to incorporate the globally-disseminated sequence type ST11, but others including a unique, previously undiscovered lineage ST2281 (allelic profile: 4-1-1-22-7-4-35) were also found and characterized. The porins OmpK35 and OmpK36 were deficient in two carbapenemase-negative carbapenem-resistant strains, suggesting decreased drug uptake as a mechanism for carbapenem resistance. This study highlights the importance of tracking hospital acquired infections, monitoring modes of antibiotic resistance to improve health outcomes of BSIs patients and to highlight the problems of XDR K. pneumoniae dissemination in healthcare settings.

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Dissemination of extensively drug-resistant and KPC-2 producing Klebsiella pneumoniae isolated from bloodstream infections

Cited by 12 publications

References 14 publications

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

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

Multidrug‐resistant Klebsiella pneumoniae in hospital‐acquired infections: Concomitant analysis of antimicrobial resistant strains

Extensively Drug-Resistant Klebsiella pneumoniae Causing Nosocomial Bloodstream Infections in China: Molecular Investigation of Antibiotic Resistance Determinants, Informing Therapy, and Clinical Outcomes

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