Emergence of carbapenem-resistant Klebsiella spp. infections in a Turkish university hospital: epidemiology and risk factors

Abstract

Introduction: Risk factors for nosocomial carbapenem-resistant Klebsiella spp. (CRK) infections were analyzed in this study. Methodology: The incidence, clinical characteristics, risk factors, antimicrobial susceptibility, and outcomes of CRK infections during a seven-year period (2004)(2005)(2006)(2007)(2008)(2009)(2010) were retrospectively analyzed. Results: A total of 720 patients were included in the study. Carbapenem resistance among Klebsiella spp. was significantly increased between 2003 and 2007 (p < 0.001). CRK strains were mostly isolated from intensive care units (ICUs) (p < 0.001). Using imipenem and cefoperazone-sulbactam within the prior three months, staying in ICU, receiving immunspressive therapy, receiving H2 receptor antagonists, having a tracheostomy, using mechanical ventilation, hemodialysis, and having a urinary catheter were found to be significant risk factors for carbapenem-resistant Klebsiella spp. infections. In a multivariate analysis, previously using imipenem (OR 3.35; CI 1.675-6.726, p < 0.001), staying in ICU (OR 3.36;; p = 0.022), and receiving H2 receptor antagonist (OR 4.49; 95% CI 1.011-19.951; p = 0.048) were independently associated with carbapenem resistance. Respiratory tract infections were the most common nosocomial infections. Attack mortality rate was significantly higher in patients infected with CRK strains (p < 0.001). CRK strains showed significantly higher resistance rates to other antibiotics. Conclusions: The emergence and rapid spread of CRK strains in our hospital is worrisome. The patients in the ICU are at the highest risk for the acquisition of CRK strains. High resistant rates to other antibiotics except colistin and tigecycline limit therapeutic options, and increase mortality rates.

Colistin Resistance in Carbapenem-Resistant Klebsiella Pneumoniae Strains

“…Dizbay et al [24] analyzed nosocomial infections produced by carbapenem-resistant Klebsiella spp. in ICU and their risk factors.…”

Antimicrobial resistance of selected invasive bacteria in a tertiary care center: results of a prospective surveillance study

“…and K. pneumoniae were the most common pathogens isolated from blood, accounting for more than half of all tested blood isolates, while S. aureus, E. faecalis, E. faecium, E. coli, P. aeruginosa, and S. pneumoniae together accounted for the other half. Other hospitals worldwide are facing increasing trends of Gram-negative bacteremia, which poses a great concern considering their persisting nature in the medical setting and diminished susceptibility to available antibiotics [10,11].…”

Carbapenem-resistant Enterobacteriaceae

“…According to the NHSN, the prevalence of 2009-2010 CR Klebsiella strains has reached 12% in invasive device-related infections (18). (3,(26)(27)(28)(29). According to the 2011 data in Asia-Pacific countries, the mean resistance rate was 9% in CR Klebsiella spp.…”

“…Moreover, the treatment options are becoming limited with increasing resistance. The health care--related infections due to carbapenem-resistant Enterobacteriaceae (CRE) have been reported increasingly from all over the world in recent years (1)(2)(3). The CRE infections were first reported in the 1990s, but have reached the levels that can cause problems in clinical practice (4).…”