Molecular epidemiology and risk factors for colistin- or tigecycline-resistant carbapenemase-producing Klebsiella pneumoniae bloodstream infection in critically ill patients during a 7-year period

Papadimitriou-Olivgeris, Matthaios; Bartzavali, Christina; Spyropoulou, Aikaterini; Lambropoulou, Anastasia; Sioulas, Nektarios; Vamvakopoulou, Sophia; Karpetas, Georgios; Spiliopoulou, Iris; Vrettos, Theofanis; Anastassiou, Evangelos D.; Fligou, Fotini; Christofidou, Myrto; Marangos, Markos

doi:10.1016/j.diagmicrobio.2018.06.001

Cited by 21 publications

(19 citation statements)

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“…Although ICU-BSI K. pneumoniae acquired great resistance to most antibiotics, it was relatively susceptible to tigecycline and colistin, which supported them as potential choices for empirical treatment of ICU-BSI caused by K. pneumoniae . However, in critically ill patients, frequent administration of colistin and tigecycline were considered as risk factors for colistin and tigecycline-resistant K. pneumoniae BSIs, respectively ( 25 ). Therefore, some new antibiotics have been developed, such as ceftazidime-avibactam, which can improve the prognosis of bacteremia associated with carbapenem-resistant K. pneumoniae deprived of metallo-β-lactamase ( 26 – 28 ) and can decrease the usage of tigecycline and colistin to slow down the evolution of antibiotic resistance.…”

Section: Discussionmentioning

confidence: 99%

Drug Susceptibility and Molecular Epidemiology of Klebsiella pneumoniae Bloodstream Infection in ICU Patients in Shanghai, China

et al. 2021

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Background: Bloodstream infections (BSIs) are recognized as important nosocomial infections. Klebsiella pneumoniae is one of the major causes of bacteremia. This retrospective study focused on drug susceptibility and molecular epidemiology of K. pneumoniae isolated from intensive care unit (ICU) patients with BSI in Shanghai, China.Methods: Consecutive K. pneumoniae isolates were collected from ICU patients. Antibiotic susceptibility testing was conducted by the broth microdilution method. PCR was performed to detect antimicrobial resistance genes. We also completed multilocus sequence typing (MLST) and GoeBURST was used to analyze the result of MLST.Results: A total of 78 K. pneumoniae isolates were enrolled. K. pneumoniae from ICU-BSIs were highly resistant to almost all common antibiotics. The most frequent resistance determinants responsible for extended-spectrum β-lactamase (ESBL) producers were blaCTX−M−14, blaCTX−M−15, and blaCTX−M−55. KPC was the only enzyme, which was detected by the carbapenemase producers. The most principal sequence types (STs) were ST11, ST15, and ST23.Conclusion: This study presents for the first time the antibiotic resistance phenotype and molecular epidemiology of K. pneumoniae isolated from ICU patients with BSIs in Shanghai. ICU-BSI K. pneumoniae is characteristic of a high resistance rate. The occurrence of the KPC-2 enzyme may result from nosocomial clonal dissemination of ST11 K. pneumoniae.

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Section: Discussionmentioning

confidence: 99%

Drug Susceptibility and Molecular Epidemiology of Klebsiella pneumoniae Bloodstream Infection in ICU Patients in Shanghai, China

et al. 2021

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“…In the last decades, there has been an important paucity of agents for adequately treating patients with CP-Kp bacteraemia [4]. Before the revision of tigecycline's breakpoints, resistance rates to tigecycline were lower than other treatment options, such as colistin or aminoglycosides, leading to its wide use [3,12,13]. In 2019, the revision of tigecycline's breakpoints resulted in a significant change of its susceptibility rates; in the present study, 89.4% of isolates were resistant according to 2019's EUCAST breakpoints, whereas if the previous breakpoints were used, the resistance rate would drop to 30.8%.…”

Section: Discussionmentioning

confidence: 99%

“…In 2019, the European Committee on Antimicrobial Susceptibility Testing (EUCAST) revised the minimum inhibitory concentration (MIC) breakpoints for tigecycline [10]; prior to 2019, an isolate was considered susceptible if the MIC was ≤ 1 mg/L and resistant if MIC was > 2 mg/L [11]; since 2019, an isolate with MIC > 0.5 mg/L has been considered resistant [10]. This revision rendered most of the isolates that were previously considered as susceptible to be considered resistant [12].…”

Section: Introductionmentioning

confidence: 99%

Impact of Tigecycline’s MIC in the Outcome of Critically Ill Patients with Carbapenemase-Producing Klebsiella pneumoniae Bacteraemia Treated with Tigecycline Monotherapy—Validation of 2019′s EUCAST Proposed Breakpoint Changes

Papadimitriou-Olivgeris

Bartzavali

Nikolopoulou

et al. 2020

Antibiotics

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Background: Tigecycline is a therapeutic option for carbapenemase-producing Klebsiella pneumoniae (CP-Kp). Our aim was to evaluate the impact of the tigecycline’s minimum inhibitory concentration (MIC) in the outcome of patients with CP-Kp bacteraemia treated with tigecycline monotherapy. Methods: Patients with monomicrobial bacteraemia due to CP-Kp that received appropriate targeted monotherapy or no appropriate treatment were included. Primary outcome was 30-day mortality. MICs of meropenem, tigecycline, and ceftazidime/avibactam were determined by Etest, whereas for colistin, the broth microdilution method was applied. PCR for blaKPC, blaVIM, blaNDM, and blaOXA genes was applied. Results: Among 302 CP-Kp bacteraemias, 32 isolates (10.6%) showed MICs of tigecycline ≤ 0.5 mg/L, whereas 177 (58.6%) showed MICs that were 0.75–2 mg/L. Colistin and aminoglycoside susceptibility was observed in 43.0% and 23.8% of isolates, respectively. The majority of isolates carried blaKPC (249; 82.5%), followed by blaVIM (26; 8.6%), both blaKPC and blaVIM (16; 5.3%), and blaNDM (11; 3.6%). Fifteen patients with tigecycline MIC ≤ 0.5 mg/L and 55 with MIC 0.75–2 mg/L were treated with tigecycline monotherapy; 30-day mortality was 20.0% and 50.9%, respectively (p = 0.042). Mortality of 150 patients that received other antimicrobials was 24.7%; among 82 patients that received no appropriate treatment, mortality was 39.0%. No difference in 30-day mortality was observed between patients that received tigecycline (MIC ≤ 0.5 mg/L) or other antimicrobials. Conclusion: Tigecycline monotherapy was as efficacious as other antimicrobials in the treatment of bloodstream infections due to CP-Kp isolates with a tigecycline’s MIC ≤ 0.5 mg/L.

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“…40,41 A single-center study from Greece evaluated risk factors for development of colistin-resistant carbapenemase-producing K. pneumoniae and found in multivariate analysis that colistin administration and tracheostomy were independently associated with infections due to colistin-resistant carbapenemase-producing K. pneumoniae as compared with colistin-sensitive carbapenemase-producing K. pneumoniae. 42 Colonization is another factor that guides empiric therapy decisions and potentially impacts patient outcomes. A study from Greece identified previous ICU stay, chronic obstructive pulmonary disease, duration or previous hospitalization, prior carbapenem exposure, and prior β-lactam/β-lactamase inhibitor exposure as risk factors for enteric colonization with a KPC-producing K. pneumoniae.…”

Section: Risk Factors For Infection Colonization and Mortalitymentioning

confidence: 99%

Difficult-to-Treat Antibiotic-Resistant Gram-Negative Pathogens in the Intensive Care Unit: Epidemiology, Outcomes, and Treatment

Strich

Kadri

2019

Semin Respir Crit Care Med

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Antibiotic resistance among gram-negative pathogens is a world-wide problem that poses a constant threat to patients in the intensive care unit and a therapeutic challenge for the intensivist. Furthermore, the substantial economic burden and increased mortality associated with infections due to highly resistant gram-negative pathogens exacerbate these challenges. Understanding the mechanisms, epidemiology, and risk factors for these infections is paramount to the successful control of outbreaks and for guiding therapy which often entails use of antibiotics with suboptimal efficacy and/or toxicity profiles. In this review we will discuss the global epidemiology, burden, risk factors, and treatment of highly resistant gram-negative infections as they apply to the intensive care population.

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Molecular epidemiology and risk factors for colistin- or tigecycline-resistant carbapenemase-producing Klebsiella pneumoniae bloodstream infection in critically ill patients during a 7-year period

Cited by 21 publications

References 30 publications

Drug Susceptibility and Molecular Epidemiology of Klebsiella pneumoniae Bloodstream Infection in ICU Patients in Shanghai, China

Drug Susceptibility and Molecular Epidemiology of Klebsiella pneumoniae Bloodstream Infection in ICU Patients in Shanghai, China

Impact of Tigecycline’s MIC in the Outcome of Critically Ill Patients with Carbapenemase-Producing Klebsiella pneumoniae Bacteraemia Treated with Tigecycline Monotherapy—Validation of 2019′s EUCAST Proposed Breakpoint Changes

Difficult-to-Treat Antibiotic-Resistant Gram-Negative Pathogens in the Intensive Care Unit: Epidemiology, Outcomes, and Treatment

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