Molecular epidemiology and risk factors of bloodstream infections caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae

Mosqueda, Juan L.; Montaño-Loza, Aldo J.; Rolón, Ana Lilia; Cervantes, Carlos; Bobadilla-del-Valle, Miriam; Silva-Sánchez, Jesús; Garza–Ramos, Ulises; Villası́s-Keever, Angelina; Galindo-Fraga, Arturo; Palacios, Guillermo M. Ruiz; Ponce-de-León, Alfredo; Sifuentes–Osornio, José

doi:10.1016/j.ijid.2008.03.008

Cited by 53 publications

(35 citation statements)

References 23 publications

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“…Mortality rates following K. pneumoniae bacteremia ranged from 27.4 to 37% (33,(80)(81)(82)(83). The higher risk of mortality due to K. pneumoniae bacteremia is associated with a number of patient factors, including patients being admitted to the ICU, being more than 65 years old, having an underlying malignancy, presenting with pneumonia, requiring mechanical ventilation or urinary catheters, or being alcoholics (33,(80)(81)(82)(83)(84). Of grave concern to the medical community is the increase in antibiotic resistance that makes treatment of lung and bladder K. pneumoniae infections more difficult and extends the length of time that patients carry K. pneumoniae at these sites, allowing more opportunities for K. pneumoniae to spread to the bloodstream and brain.…”

Section: Infections Caused By K Pneumoniaementioning

confidence: 99%

Klebsiella pneumoniae: Going on the Offense with a Strong Defense

Paczosa

Mecsas

2016

Microbiol Mol Biol Rev

1,290

1,345

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SUMMARYKlebsiella pneumoniaecauses a wide range of infections, including pneumonias, urinary tract infections, bacteremias, and liver abscesses. Historically,K. pneumoniaehas caused serious infection primarily in immunocompromised individuals, but the recent emergence and spread of hypervirulent strains have broadened the number of people susceptible to infections to include those who are healthy and immunosufficient. Furthermore,K. pneumoniaestrains have become increasingly resistant to antibiotics, rendering infection by these strains very challenging to treat. The emergence of hypervirulent and antibiotic-resistant strains has driven a number of recent studies. Work has described the worldwide spread of one drug-resistant strain and a host defense axis, interleukin-17 (IL-17), that is important for controlling infection. Four factors, capsule, lipopolysaccharide, fimbriae, and siderophores, have been well studied and are important for virulence in at least one infection model. Several other factors have been less well characterized but are also important in at least one infection model. However, there is a significant amount of heterogeneity inK. pneumoniaestrains, and not every factor plays the same critical role in all virulentKlebsiellastrains. Recent studies have identified additionalK. pneumoniaevirulence factors and led to more insights about factors important for the growth of this pathogen at a variety of tissue sites. Many of these genes encode proteins that function in metabolism and the regulation of transcription. However, much work is left to be done in characterizing these newly discovered factors, understanding how infections differ between healthy and immunocompromised patients, and identifying attractive bacterial or host targets for treating these infections.

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Section: Infections Caused By K Pneumoniaementioning

confidence: 99%

Klebsiella pneumoniae: Going on the Offense with a Strong Defense

Paczosa

Mecsas

2016

Microbiol Mol Biol Rev

1,290

1,345

View full text Add to dashboard Cite

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“…17 For this reason, it is important to clarify these issues for the design of strategies aimed at reducing resistances. Other variables associated with the identification of ESBL-producing strains in patients with bloodstream infection reported in the literature are the patient's age, 15 severe underlying diseases, 13 renal transplantation, 13 previous admission to the ICU, 18 duration of hospitalization before bacteremia, 19 prior exposure to urinary catheters, 10,14,16 invasive procedure within the previous 72 hours, 16 and the nosocomial origin of bacteremia. 10 In a systematic review of studies evaluating the association between inappropriate antibiotic therapy and mortality among bacteremic patients, measurement of severity of illness without specified the time at which it was measured was considered a source of methodological heterogeneity that may explain conflicting findings.…”

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confidence: 99%

Risk factors for bloodstream infections caused by extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae

Quirante¹,

Cerrato²,

Pardos³

2011

Braz J Infect Dis

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The objective of this study was to identify risk factors for bacteremia by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae. Retrospective casecontrol study performed in a 450-bed acute care academic tertiary hospital in Barcelona, Spain. Cases included 53 patients with ESBL-producing E. coli or K. pneumoniae bacteremia, and 159 controls with non-ESBL-producing E. coli or K. pneumoniae bacteremia. Controls were matched in a 3:1 ratio to case patients according to species of infecting organism, age, and severity of illness in the 24-48h before blood sample collection for culture calculated by the Simplified Acute Physiology Score (SAPS II) system. Previous antimicrobials were more frequently administered to cases than to controls (56.5% vs 17%, p < 0.001). Binary logistic regression showed that the number (> 2) of different families of antimicrobials received within 90 days before bloodstream infection was the only predictor of ESBL-producing E. coli or K. pneumoniae in blood culture (OR = 2.29, 95% CI 1.35-3.88, p = 0.002). Conclusion: Previous use of different families of antimicrobials (more than two) in patients with bloodstream infection caused by E. coli or K. pneumoniae increased the risk for ESBL-producing strains.

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“…23 For example, a retrospective case-control study that included all cases of K. pneumoniae bacteremia from a single center in Mexico (1993Mexico ( -2002 reported that an ESBL-producing isolate was found in 17/121 cases (14%), and that prior cephalosporin use (p = 0.039) and previous stay in the intensive care unit (p = 0.033) were signifi cant risk factors for infection with ESBLproducing K. pneumoniae. 24 Local and unit-specifi c surveillance data can inform antibiotic selection by providing guidance regarding the likely pathogens and their resistance profi les. This is particularly important for selection of empiric therapy and in community-acquired infections where microbiologic data and antibiotic use information may not be available.…”

Section: Resultsmentioning

confidence: 99%

Increasing prevalence of extended-spectrum-betalactamase among Gram-negative bacilli in Latin America: 2008 update from the Study for Monitoring Antimicrobial Resistance Trends (SMART)

Villegas¹,

Blanco²,

Sifuentes–Osornio³

et al. 2011

Braz J Infect Dis

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OBJECTIVES: This analysis of the Study for Monitoring Antimicrobial Resistance Trends (SMART) evaluated the susceptibility patterns of Enterobacteriaceae in Latin America in 2008, with emphasis on susceptibility trends of E. coli and K. pneumoniae. METHODS: Clinical isolates were recovered from intra-abdominal infections (IAI) from 23 centers in 10 Latin American countries. Isolates were sent to a central laboratory for confirmation of identification, antimicrobial susceptibility and ESBL testing, following the Clinical Laboratory Standards Institute (CLSI) guidelines. RESULTS: Of 1,003 Gram-negative bacilli collected from intra-abdominal infections, E. coli and K. pneumoniae were the most commonly isolated organisms, and 26.8% of E. coli and 37.7% of K. pneumoniae were ESBL positive. Ertapenem and imipenem were the most consistently active agents tested; 99% of ESBLpositive E. coli isolates were susceptible to ertapenem and 100% to imipenem as well, and 91% of ESBL-positive K. pneumoniae were susceptible to ertapenem and 98% to imipenem. Quinolones and cephalosporins were less active, achieving 1.5% to 76% inhibition against ESBL-producing E. coli and 3.5% to 61% inhibition against K. pneumoniae. CONCLUSIONS: Local and unit-specific surveillance data is particularly important for selection of empiric therapy and in community-acquired infections as they can help the clinician with antibiotic selection by providing guidance regarding the likely pathogens and their resistance profiles. Our data also confirm the increasing frequency with which ESBL-producing organisms are found in the community setting, with 31.4% of communityacquired and 24.9% of hospital-acquired infections found to produce ESBLs. Imipenem and ertapenem are the most active agents tested for ESBL-positive E. coli and K. pneumoniae

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Molecular epidemiology and risk factors of bloodstream infections caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae

Abstract: The prevalence of ESBL-Kp was found to be lower than that previously reported in Latin America. ESBL-Kp bacteremia was not associated with a worse clinical outcome. We were able to identify a plasmid-mediated horizontal dissemination over the 10-year period.

Cited by 53 publications

References 23 publications

Klebsiella pneumoniae: Going on the Offense with a Strong Defense

Klebsiella pneumoniae: Going on the Offense with a Strong Defense

Risk factors for bloodstream infections caused by extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae

Increasing prevalence of extended-spectrum-betalactamase among Gram-negative bacilli in Latin America: 2008 update from the Study for Monitoring Antimicrobial Resistance Trends (SMART)

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