Risk Factors Affecting Clinical Outcome in Patients with Carbapenem-Resistant K. pneumoniae: A Retrospective Study

He, Guo‐Wei; Huang, Juanjuan; Huang, Shiqiong; Sun, Ji Su; Zhou, Yulv; Hong, Tao; Shen, Hui; Li, Zhuan; Liu, Jiyang

doi:10.12659/msm.925693

Cited by 5 publications

(5 citation statements)

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“…In this study, the 30-day mortality was 24.5%, which was higher than that in previous reports (38). As ICU admission, mechanical ventilation, and central venous catheterization have been considered independent risk factors for CRKP (39), the high mortality is not surprising as most of the patients in our study were high-risk patients. Another possible explanation is that the patients in our cohort are elderly, which has been found to be associated with 30-day mortality (40).…”

Section: Discussioncontrasting

confidence: 59%

Genomic Insights Into Molecular Characteristics and Phylogenetic Linkage Between the Cases of Carbapenem-Resistant Klebsiella pneumoniae from a Non-tertiary Hospital in China: A Cohort Study

Shen

Huang

et al. 2023

Jundishapur J Microbiol

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Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) strains have been listed as one of the major clinical concerns. Objectives: We investigated CPKP isolates from non-tertiary hospitals to find disseminated clones and analyze extensive phenotypic and genetic diversity in this study. Methods: In this cohort study, a total of 49 CRKP isolates from 3 hospitals in the same region were collected in 2021. The prevalence and antimicrobial susceptibility patterns were analyzed. Clinical data were retrieved from electronic medical record systems. The molecular types, antimicrobial resistance (AMR) profiles, plasmid replicons, and virulence factors were analyzed. The maximum-likelihood phylogenetic tree and transmission networks were constructed using single-nucleotide polymorphisms (SNPs). Results: The median age of patients (N = 49) was 66.0 years, and 85.7% were male. The most common CRKP infection was nosocomial pneumonia (75.5%), followed by bacteremia (10.2%). More than 53% of isolates were resistant to ceftazidime-avibactam (CAZ/AVI). Forty-five isolates were successfully sequenced; the predominant carbapenem-resistant gene was blaKPC-2 (93.3%). The 30-day mortality in our cohort was 24.5%. The most dominant sequence type (ST) was ST11 (60.0%), followed by ST15 (13.3%). Whole genome sequencing (WGS) analysis exhibited dissemination of ST11 strain clones, ST420, and ST15 clones, both within and outside the given hospital. Conclusions: In this surveillance study, several dissemination chains of CRKP were discovered in the hospital and the region, as ST11 was the main epidemic clone. Our findings suggest that effective infection control practices and antimicrobial stewardship are needed in non-tertiary hospitals in China.

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Section: Discussioncontrasting

confidence: 59%

Genomic Insights Into Molecular Characteristics and Phylogenetic Linkage Between the Cases of Carbapenem-Resistant Klebsiella pneumoniae from a Non-tertiary Hospital in China: A Cohort Study

Shen

Huang

et al. 2023

Jundishapur J Microbiol

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“…In Hebei Province, the resistance rate of CRKP to sulfamethoxazole is low, which is consistent with the results of He et al and Lombardi. 44 , 45 A recent study found that in vitro, compound sulfamethoxazole combined with polymyxin can quickly kill clinically isolated CRKP within 2–24 h, but this result needs further evidence-based medicine and clinical research certification. 46 From 2017 to 2019, the MIC50/MIC90 of CRKP to imipenem and meropenem in Hebei Province was 16/32 µg/mL ( Table 4 ).…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Carbapenem-Resistant Klebsiella pneumoniae Infection in a Northern Province in China: Clinical Characteristics, Drug Resistance, and Geographic Distribution

Wang¹,

Zhan²,

Liu³

et al. 2022

IDR

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Purpose In this study, we analyzed the clinical distribution and drug resistance of carbapenem-resistant Klebsiella pneumoniae (CRKP) strains, the minimum inhibitory concentrations (MIC), MIC50 and MIC90, and geographical distribution in Hebei Province, China. We aimed to provide epidemiological research data, formulate appropriate combined treatment schemes, reasonably select antibiotics, and standardize nosocomial infection control schemes. Patients and Methods A total of 6328 strains of CRKP were collected from 2017 to 2019. The MIC was determined for the drug sensitivity test, and the experimental data were statistically analyzed using WHONET5.6. Results The detection rate of CRKP increased annually from 13.4% in 2017 to 14.5% in 2018, and 14.6% in 2019. The ratio of males to females was approximately 2:1; 53.6% were elderly, 39% were adults, 4.8% were minors, and 2.5% were newborns. The specimens collected were mainly sputum (70.9%). The resistance rate of CRKP to carbapenems and other β-lactam antibiotics was found to be increasing, with resistance rates generally greater than 90%. The resistance rate to aminoglycoside antibiotics decreased yearly to approximately 50%, and the resistance rate to quinolones remained unchanged at approximately 80%. From 2017 to 2019, the resistance rate of CRKP in Hebei Province to various antibiotics was high, and the resistance rate to β-lactam antibiotics increased each year. Conclusion The situation of CRKP resistance is severe in Hebei Province, China. The resistance rate to most antibiotics is very high and shows an upward trend. Among them, the resistance rate to polymyxin is low; however, few resistant strains do exist. MIC50 and MIC90 are higher than their MICs. It mainly causes lung infection in elderly men. This study is helpful to improve the diagnosis, treatment, and prevention of CRKP infection in our province.

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“…Previous studies showed that intensive care unit (ICU) admission, exposure to carbapenems, surgery, mechanical ventilation, central venous catheterization, indwelling gastric tube and nasogastric intubation are independent risk factors for CRKP. 7 , 8 In addition, multiple studies have concluded that CRKP could increase the mortality rate of KP to about 40–50%. 9 , 10 Therefore, a comprehensive understanding of the clinical characteristics, risk factors, and outcomes of patients with CRKP infection will aid surveillance and diagnostic initiatives, and help clinicians adjust treatment strategies.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Risk Factors and Mortality of Patients with Carbapenem-Resistant Klebsiella pneumoniae Infection

Wu¹,

Zheng²,

Yao³

2022

IDR

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Background Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection is associated with high mortality and has become a major public problem threatening patients. This study aimed to explore risk factors for death in patients with Klebsiella pneumoniae (KP) and identify risk factors for CRKP infection. Methods The study retrospectively analyzed clinical characteristics and microbiological data from patients infected with KP from January 2019 to October 2021 to identify risk factors and mortality, using multivariate logistic regression analysis and Cox regression analysis. Results A total of 214 KP inpatients were enrolled in our study. The in-hospital mortality rate was significantly higher in patients infected with CRKP (13/68, 19.12%) than carbapenem-susceptible KP (CSKP) (2/146, 1.37%) and the difference was statistically significant (P= 0.03). Multivariate Cox regression analysis showed CRKP isolation (HR 12.26, 95% CI 2.43–61.68, P = 0.002), lower TP (HR 10.50, 95% CI 1.33–82.76, P = 0.03), antibiotic days of therapy >15 (HR 0.08, 95% CI 0.01–0.56, P= 0.01) and length of stay (LOS) (HR 0.03, 95% CI 0.002–0.61, P= 0.02) were independent risk factors for death from KP. Additionally, intensive care unit (ICU) stay (OR 21.69, 95% CI 4.50–118.76, P< 0.001) and previous carbapenem exposure (OR 5.26, 95% CI 1.38–21.19, P= 0.02) are independent risk factors for CRKP. Conclusion Our findings showed that patients infected with CRKP have a higher in-hospital mortality rate. Identifying the independent risk factors for CRKP infection may contribute to the management of CRKP and reduce the mortality of KP patients.

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Risk Factors Affecting Clinical Outcome in Patients with Carbapenem-Resistant K. pneumoniae: A Retrospective Study

Cited by 5 publications

References 32 publications

Genomic Insights Into Molecular Characteristics and Phylogenetic Linkage Between the Cases of Carbapenem-Resistant Klebsiella pneumoniae from a Non-tertiary Hospital in China: A Cohort Study

Genomic Insights Into Molecular Characteristics and Phylogenetic Linkage Between the Cases of Carbapenem-Resistant Klebsiella pneumoniae from a Non-tertiary Hospital in China: A Cohort Study

Prevalence of Carbapenem-Resistant Klebsiella pneumoniae Infection in a Northern Province in China: Clinical Characteristics, Drug Resistance, and Geographic Distribution

Analysis of Risk Factors and Mortality of Patients with Carbapenem-Resistant Klebsiella pneumoniae Infection

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