Early KPC-Producing Klebsiella pneumoniae Bacteremia among Intensive Care Unit Patients Non-Colonized upon Admission

Abstract

Among 140 patients colonized by KPC-producing Klebsiella pneumoniae (KPC-Kp) between fourth and seventh day of Intensive Care Unit stay, 24 developed bacteraemia immediately after colonization. Colistin-resistance of the colonizing isolate was the factor significantly associated with early KPC-Kp bacteraemia (P < 0.001; OR 6.6, 95% CI 2.4-18.4), a worrisome finding since infections by colistin-resistant isolates is associated with increased mortality due to limited remaining therapeutic options.

Screening for antimicrobial-resistant Gram-negative bacteria in hospitalised patients, and risk of progression from colonisation to infection: Systematic review

“…Eighty-six studies were included in SR1 . Six studies 30,[92][93][94][95]97 were excluded from SR1 but included in SR2 and 49 studies fulfilled eligibility criteria for both SR1 and SR2 13,14,16,[19][20][21][22][23][24][26][27][28][29][31][32][33][34]36,39,40,43,[45][46][47]49,50,52,53,[55][56][57][58][59]64,65,67,68,[71][72][73]77,82,84,86,[89][90]…”

“…Out of 86 studies included in SR1 , 75 were included in qualitative analysis 13,14,[16][17][18][19][20][21][22][23][24][25]27,28,30,[32][33][34][35][36][38][39][40][41][74][75][76][77][78][79][80][81][82][83]85,86,90,91 as two reported on repeated screening procedures (excluding two studies 34,63 ) and nine reported on screening activities in outbreak situations 15,29,31,37,42,84,[87][88][89] . Among included studies, 24 concerned routine care screenings 41,…”

“…Screening was performed at hospital admission in 35 studies 13,14,17,21,24,25,27,30,41,44,48,50,51,54,[60][61][62][63]66,69,70,[74][75][76][78][79][80][81][82][83]90 and at admission and repeatedly in 40 studies 16,[18][19][20]22,23,26,28,[32][33][34][35][36][38][39][40]43,[45][46][47]49,52,…”

“…Screening of all admitted patients was conducted either at the time of arrival to hospital (n=6; 8%) 19,44,63,74,78,82 or at admission to a specific ward (n=45; 60%) 13,14,16,17,20,21,[23][24][25][26]28,[32][33][34]36,[38][39][40]43,[45][46][47][51][52][53]55,[57][58][59][60]62,64,67,[69][70][71][72][75][76][77]80,81,86,90 . High-risk patients-based screening (n=24 studies, 32%) targeted patients with defined clinical conditions (mostly oncologic patients) (9, 37%) 22,…”

Hypervirulence and Multiresistance to Antibiotics in Klebsiella pneumoniae Strains Isolated from Patients with Hospital- and Community-Acquired Infections in a Mexican Medical Center

“…Klebsiella pneumoniae is a pathogenic bacterium associated with hospital-acquired infections [ 1 ] such as pneumonia, bacteremia, meningitis, liver abscesses, and surgical wound infections [ 2 , 3 , 4 ]; it also causes chronic community-acquired urinary tract infections [ 5 ]. The pathogenicity of K. pneumoniae is the result of a combination of different virulence factors such as adhesins ( fimH-1 , mrkD , kpn , and ycfM ) involved in epithelial cell adhesion and biofilm formation; iron-acquisition systems ( entB , iutA , irp1 , irp2 , ybtS , fyuA , and iroN ); protectins ( magA and rmpA ); and toxins ( hlyA and cnf-1 ) [ 6 ].…”