Predictors of Occurrence and 30-Day Mortality for Co-Infection of Carbapenem-Resistant Klebsiella pneumoniae and Carbapenem-Resistant Acinetobacter baumannii

Abstract

BackgroundThe phenomenon of co-infection with multiple carbapenem-resistant bacteria is growing, which pose a great challenge for infection control and treatment. This study aimed to analyze predictors of occurrence and 30-day mortality for carbapenem-resistant Klebsiella pneumoniae and carbapenem-resistant Acinetobacter baumannii co-infection.MethodsFrom June 2018 to June 2021, clinical data of 103 patients co-infected with carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Klebsiella pneumoniae (CRKP) were collected from a tertiary teaching hospital in Anhui Province, China. The clinical characteristics and predictors of mortality were analyzed. Meanwhile, the bacterial isolates were characterized for drug susceptibility, multi-locus sequence typing, and drug resistance genes.ResultsThe multivariate analysis revealed that fiberoptic bronchoscopy (p = 0.005, OR=2.72), repeat transfusions (p = 0.008, OR= 2.23) and exposure to tigecycline (p = 0.002, OR = 6.58) were independent risk factors for CRKP and CRAB co-infection. Neutrophil ≥11.9*109 (p = 0.035, adjusted HR = 3.12) and C-reactive protein ≥ 149 mg/L (p = 0.009, adjusted HR = 4.41) were found associated with 30-day mortality. Combined neutrophil with C-reactive protein could predict 30-day mortality, of which AUC value was 0.791 (95%CI: 0.661-0.921). KPC (46/51, 90.2%) was the most common carbapenemase in CRKP. 33 isolates of CRKP belong to ST11 (33/51, 64.7%), and three new ST types ST5882, ST5883, ST5885 were detected.ConclusionsInvasive operations and antibiotics exposure can lead to CRKP and CRAB co-infection. Combined neutrophil with C-reactive protein could predict 30-day mortality.

Evaluation of synergistic activity of antibiotic combinations in extensive drug-resistant Acinetobacter species using checkerboard assay

“…Although many researchers [40][41][42] have resorted to tigecycline, this broad-spectrum antibiotic, as the last effective therapeutic option in difficult-to-treat patients, especially those with MDR Acinetobacter infections, there is no antibiotic without side effects. Tigecycline is known for its hepatotoxicity, and there is a debate regarding its association with increased mortality rates [43][44][45][46][47]. Moreover, bacteria began to develop resistance against tigecycline [48].…”

Clinical and molecular characteristics of Klebsiella pneumoniae infection in a tertiary general hospital of Wuhan, China

“…K. pneumoniae and A. baumannii have a mutually beneficial relationship, protecting and feeding each other to promote their survival [ 28 ]. Plasmids carrying resistance genes can also be transferred between them [ 29 ]. Accordingly, we found that the coexistence of carbapenem-resistant A. baumannii was associated with CRKP infection.…”

Novel evidence on sepsis-inducing pathogens: from laboratory to bedside

“…Consistently, iucA, rmpA, rmpA2, iroB, and peg-344, were recently described as the most prevalent virulence genes in Taiwan (Liao et al, 2022), while genes ybt, iuc, and rmp were recently described as the most prevalent in China (Cienfuegos-Gallet et al, 2022). Co-infection of K. pneumoniae with other bacterial agents (i.e., Acinetobacter baumannii, P. aeruginosa, and E. coli, among other less frequent bacteria) has been documented and sized previously (Karakonstantis et al, 2022;Lv et al, 2022).…”