Molecular Epidemiology and Risk Factors of Carbapenem-Resistant Klebsiella pneumoniae Infections in Eastern China

Abstract

Background: The increasing prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) poses an immediate threat to treatment worldwide. This retrospective study assessed the molecular epidemiology and determined the risk factors for and outcomes of CRKP infections in a general teaching hospital in Shanghai, China.Methods: From January 2013 to July 2015, 100 consecutive unique CRKP isolates isolated from hospitalized patients were collected. Isolates were screened for antibiotic resistance genes by polymerase chain reaction and molecular typing was performed by pulsed-field gel electrophoresis (PFGE). Patients infected with CRKP comprised the case group and were compared to the control group of patients infected with carbapenem-susceptible Klebsiella pneumoniae. Therapeutic effects were compared in the CRKP infection group.Results: Among the 100 CRKP isolates, the percentages of multidrug-resistant, extensively drug-resistant (XDR), and pandrug-resistant were 50.0, 50.0, and 0%, respectively. All the CRKP isolates produced KPC-2 and could be divided into 18 PFGE clusters (A–O) and 70 subtypes. No dominant intra-hospital PFGE type was detected using a cutoff of 80% similarity. The ratio of CRKP infection to colonization was 51 to 49. Risk factors correlated with CRKP infection included pulmonary disease (p = 0.038), ICU stay (p = 0.002), invasive ventilation (p = 0.009), blood transfusion (p = 0.028), parenteral nutrition (p = 0.004), sputum suction (p = 0.006), medical history of previous hospitalization (p = 0.022), exposure to antibiotics 90 days before infection (p = 0.030), and antibiotic exposure during hospital stay including carbapenems (p = 0.013), enzyme inhibitors (p = 0.021), nitroimidazoles (p = 0.029), and glycopeptides (p = 0.000). Multivariable analysis showed that sputum suction (odds ratio 3.090, 95% confidence intervals 1.004–9.518, p = 0.049) was an independent risk factor for CRKP infections. Patients infected with CRKP with longer carbapenems treatment course (p = 0.002) showed better outcome.Conclusion: This study showed the severity of CRKP infection in eastern China. Sputum suction was an independent risk factor for CRKP infection. Prolonged duration of treatment with carbapenems benefited the patients infected with CRKP.

What we can do? The risk factors for multi-drug resistant infection in pediatric intensive care unit (PICU): a case-control study

“…In this present study, the incidence of MDRIs in the three PICUs was 8.72% (79/906), which is significantly lower than that of previous reports with incidence of MDRIs ranging from 10 to 25% in PICU [9,10]. Previous studies [17][18][19] have reported that the patients with MDRI were hospitalized and treated in the ICU for considerably longer stay and had lower survival rates compared to other patient groups.…”

“…Many previous studies [6][7][8] have indicated that the incidence of nosocomial infections caused by antibiotic-resistant organisms is increasing. The prevalence of hospital-acquired or nosocomial infections in pediatric patients ranges from 10 to 25% in PICU [9,10]. Therefore, the control of infection in PICU is very important.…”

In vitro Susceptibility of Multidrug-Resistant Klebsiella pneumoniae Isolates from an Egyptian Tertiary Care Hospital to Tigecycline and Colistin

“…Fortunately, tigecycline and colistin displayed a considerable activity against such strains where 87.5% and 81.25% of the carbapenemase-positive strains were susceptible to tigecycline and colistin, respectively. These findings are in a range similar to that reported by other investigators (He et al, 2015, andZheng et al, 2017).…”

<p>Risk Factors for Carbapenem-Resistant <em>Klebsiella pneumoniae</em> Bloodstream Infections and Outcomes</p>

“…Yuan et al malignancies, hematopoietic stem cell transplantation, tracheotomy, mechanical ventilation, and indwelling catheters. 5,16,17 In our study, univariate analysis results showed that ICU admission, respiratory disease, cardiovascular disease, nervous system disease, digestive disease, invasive operations, and carbapenem exposure were all risk factors for CRKP BSIs. These results are similar to those of previous studies in other parts of the world.…”