Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae in a Network of Long-Term Acute Care Hospitals

Han, Jennifer H.; Goldstein, Ellie J. C.; Wise, Jacqueleen; Bilker, Warren B.; Tolomeo, Pam; Lautenbach, Ebbing

doi:10.1093/cid/ciw856

Cited by 52 publications

(73 citation statements)

References 16 publications

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“…As opposed to our results, in this Spanish survey one half of the patients had a surgery intervention with hospitalization at intensive care unit and also bacteraemia (8). In accordance with our records was public data of Han et al (2017) carbapenem resistant Klebsiella pneumoniae, but the proportion of female gender (50.7 %) was slightly lower. In this American study related to the patients from long-term acute care hospitals, carbapenem resistant K. pneumoniae strains were mostly isolated from respiratory source (59.2 %), urinary tract (37 %) and from blood (9.4 %) (20).…”

Section: Discussionsupporting

confidence: 54%

Emergence of extended-spectrum β-lactamase (ESBL) and/or carbapenemase producing Enterobacteriaceae (CPE) and their antimicrobial resistance

Koreň¹,

Hubenakova²,

Drahovská³

et al. 2019

BLL

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OBJECTIVES: We focused on detecting the most frequent resistance mechanisms in selected multidrugresistant (MDR) strains and determining their antimicrobial resistance. BACKGROUND: MDR pathogens pose urgent public health threat due to limited treatment options, rigorous control measures and signifi cant mortality. METHODS: We confi rmed extended-spectrum β-lactamase (ESBL) and carbapenemase producing Enterobacteriaceae through guidelines, as well following β-lactamases: AmpC by cloxacillin, class A carbapenemase with phenylboronic acid, class B metallo-β-lactamase with ethylenediaminetetraacetic acid. Multilocus sequence typing was used to investigate 20 Escherichia coli strains. RESULTS: Overall 205 mostly ESBL Escherichia coli demonstrated resistance against amikacin (4.7 %), tigecycline (1.2 %), and no resistance to ceftazidime/avibactam, meropenem, nitrofurantoin and fosfomycin. Out of 41 Klebsiella species (spp.), 37 (90.2 %) showed carbapenemase activity, 13 (35.1 %) of class A and 24 (64.9 %) of class B. Resistance was following: meropenem 66.7 %, tigecyclin 10.2 % and colistin 0 %. From Enterobacter spp. 21 strains, 14 (66.7 %) were ESBL, 5 produced ESBL and/or AmpC and 2 were MDR. We ascertained 14 (70 %) E. coli sequence type-ST131. CONCLUSIONS: The study revealed various resistance mechanisms in concert with different agents and association of specifi c ST131 within E. coli. These characteristics considerably contribute to emergence of antimicrobial resistance (Tab. 4, Ref. 30).

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Section: Discussionsupporting

confidence: 54%

Emergence of extended-spectrum β-lactamase (ESBL) and/or carbapenemase producing Enterobacteriaceae (CPE) and their antimicrobial resistance

Koreň¹,

Hubenakova²,

Drahovská³

et al. 2019

BLL

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“…As previously reported, the majority of KPC-producing K. pneumoniae isolates in China belong to a common sequence type, ST11 (26). In contrast, a majority of these isolates in the United States belong to the ST258 type (27).…”

Section: Discussionsupporting

confidence: 56%

“…In this study, resistance rates to gentamicin, amikacin and levo oxacin were found to be 100%, 81.1% and 85.5%, respectively. These values are higher than those reported from both other provinces of China and other countries [26,27]. A retrospective study in China showed that, in an outbreak of nosocomial neonatal CRKP infection, the MICs of CRKP strains producing KPC-2 are higher than those of strains producing NDM-1 [28].…”

Section: Discussionmentioning

confidence: 64%

Molecular Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae Infections in Southwest China

Yuan

et al. 2020

Preprint

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Background: We determined epidemiological characteristics and resistance mechanisms of carbapenem-resistant Klebsiella pneumoniae (CRKP) strains found in Southwest China and assessed disease burden to provide evidence-based strategies for control and treatment of CRKP infection. Methods: A total of 159 strains of CRKP were isolated from sputa, blood, urine, ascites and wound secretions from three tertiary hospitals in Southwest China between August 1st, 2018 and December 31st, 2019. The sensitivity of each strain to 12 antibiotic agents was determined by micro-broth dilution. Identification of carbapenemase genes and multi-locus sequence typing (MLST) were performed using polymerase chain reaction (PCR). The disease burdens of patients with CRKP were assessed based on invasive procedures, antibiotic use, laboratory tests and clinical outcomes. Results: Of 159 CRKP strains analyzed, 50.9% were isolated from sputum samples. The percentage of patients who underwent invasive procedures before positive cultures for CRKP were detected was 96.3%. The mortality of blood infection was highest (66.6%) among patients with CRKP infection. All strains were insensitive to carbapenems. The resistance rates to levofloxacin and amikacin were 85.5% and 81.8%, respectively. All CRKP strains produced carbapenemases, with a majority of isolates (81.1%) producing KPC-2. The MICs of strains harbouring both KPC-2 and NDM-1 were higher than those of strains with only KPC-2 or NDM-1. ST11 is the most popular clonotype found in Southwest China. Conclusions: CRKP strains in Southwest China are characterized by strong drug resistance and associated with poor clinical prognoses. It is therefore urgent to both strengthen control measures and improve prevention awareness.

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“…The common practice of routine administration of broad-spectrum antibiotics to treat an infection before identification of the specific pathogen responsible for an infection has proven to be an ill-advised practice. By removing the normal bacterial microflora, antibiotics actually provide an opportunistic niche for the emergence of antibiotic-resistant bacterial strains which no longer have to compete with the normal bacterial populations present in the body [71,72]. Klebsiella pneumoniae is a Gram negative, facultative anaerobic commensal microorganism that can cause chronic urinary tract and soft tissue infections, pneumonia, and sepsis, and mostly occurs in immunocompromised patients [73].…”

Section: Commercial Development Of Antibioticsmentioning

confidence: 99%

“…The emergence of multi-drug-resistant bacterial infections in hospitalized patients with underlying morbidity is of particular concern [77]. In a recent US epidemiology study [72] 25% of K. pneumoniae infections in long-term acute care hospitals were resistant to carbapenems, which are currently used to treat penicillin-resistant Gram-negative pathogens. The most common condition caused by Klebsiella bacteria outside the hospital environment is pneumonia, bronchopneumonia and bronchitis and has a death rate around 50%, even when antimicrobial therapy is administered.…”

Section: Commercial Development Of Antibioticsmentioning

confidence: 99%

The Glucosinolates: A Sulphur Glucoside Family of Mustard Anti-Tumour and Antimicrobial Phytochemicals of Potential Therapeutic Application

Melrose

2019

Biomedicines

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This study reviewed aspects of the biology of two members of the glucosinolate family, namely sinigrin and glucoraphanin and their anti-tumour and antimicrobial properties. Sinigrin and glucoraphanin are converted by the β-sulphoglucosidase myrosinase or the gut microbiota into their bioactive forms, allyl isothiocyanate (AITC) and sulphoraphanin (SFN) which constitute part of a sophisticated defence system plants developed over several hundred million years of evolution to protect them from parasitic attack from aphids, ticks, bacteria or nematodes. Delivery of these components from consumption of cruciferous vegetables rich in the glucosinolates also delivers many other members of the glucosinolate family so the dietary AITCs and SFN do not act in isolation. In vitro experiments with purified AITC and SFN have demonstrated their therapeutic utility as antimicrobials against a range of clinically important bacteria and fungi. AITC and SFN are as potent as Vancomycin in the treatment of bacteria listed by the World Health Organisation as antibiotic-resistant “priority pathogens” and also act as anti-cancer agents through the induction of phase II antioxidant enzymes which inactivate potential carcinogens. Glucosinolates may be useful in the treatment of biofilms formed on medical implants and catheters by problematic pathogenic bacteria such as Pseudomonas aeruginosa and Staphylococcus aureus and are potent antimicrobials against a range of clinically important bacteria and fungi. The glucosinolates have also been applied in the prevention of bacterial and fungal spoilage of food products in advanced atmospheric packaging technology which improves the shelf-life of these products.

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Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae in a Network of Long-Term Acute Care Hospitals

Abstract: Nearly 25% of K. pneumoniae clinical isolates in a US network of LTACHs were CRKP. Expansion of national surveillance efforts and improved communication among LTACHs and acute care hospitals will be critical for reducing the continued emergence of CRKP across the healthcare continuum.

Cited by 52 publications

References 16 publications

Emergence of extended-spectrum β-lactamase (ESBL) and/or carbapenemase producing Enterobacteriaceae (CPE) and their antimicrobial resistance

Emergence of extended-spectrum β-lactamase (ESBL) and/or carbapenemase producing Enterobacteriaceae (CPE) and their antimicrobial resistance

Molecular Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae Infections in Southwest China

The Glucosinolates: A Sulphur Glucoside Family of Mustard Anti-Tumour and Antimicrobial Phytochemicals of Potential Therapeutic Application

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