Risk factors and epidemiologic predictors of blood stream infections with New Delhi Metallo-b-lactamase (NDM-1) producingEnterobacteriaceae

Abstract

Carbapenem-resistantEnterobacteriaceaeconferred by New Delhi metallo-b-lactamase (NDM-1) resistance mechanism are endemic in India and Southeast Asia. An understanding of risk factors for NDM-1 infections is necessary to guide prevention strategies. We performed a retrospective case-control study of patients admitted at Christian Medical College Hospital, Vellore, India between May 2010 and August 2014 withKlebsiella pneumoniaeblood stream infection (BSI). We compared patients with BSI caused by NDM-1 producing strains to two control groups: BSI with other multidrug resistant (MDR) strains and BSI with pan-susceptible strains. The study groups were assessed for risk factors for the outcomes: (1) infection with any MDR strain compared to pan-susceptible; and, (2) infection with NDM-1 strain as compared with other MDR and (3) Mortality. A total of 101 patients with BSI with NDM-1 producingKlebsiella pneumoniaewere matched to two groups of controls: 112 with non-NDM-1 MDR strains and 101 with pan-susceptible strains. Medical (OR 10.4) and neonatal (OR 0.7) ICU admission, central venous catheter placement (CVC, OR 7.4) predicted MDR BSI. Prior carbapenem use (OR 8.4) and CVC (OR 4.8) predicted acquisition of an NDM-1 strain. Significant predictors for mortality included ICU stay (OR 3.0), mechanical ventilation (OR 3.2), female gender (OR 2.2), diabetes (OR 0.4). CVC placement, prior carbapenem use and ICU admission were significantly associated with BSI with NDM-1 producing and other MDR strains.

Successful control of the first carbapenem-resistant Klebsiella pneumoniae outbreak in a Chinese hospital 2017–2019

“…According to this, the AMS workers asked physicians to submission of active surveillance cultures timely. Invasive devices and ICU admission has been reported that significantly associated with CRKP strains [31][32][33]. Here we found that 12 of our patients at ICU and 29 of our patients received invasive devices including 5 neurosurgery patients.…”

Multi-drug resistance bacteria predict mortality in blood stream infection in a tertiary setting in Tanzania

“…248 As expected, patients admitted in ICU suspected with BSI had high risk of mortality compared to 249 those admitted in non-ICU wards. This finding is in line with other earlier studies on risk factors 250 for BSI (6,8). We observed that unlike patients admitted in non-ICU, patients in ICU were likely 251 to have other underlying diseases.…”

Therapeutic Options for Metallo-β-Lactamase-Producing Enterobacterales

“… 13 , 24 One study comparing patients infected with MBL-producing Enterobacterales versus those infected with other multidrug-resistant isolates found that prior carbapenem use and central venous catheterization were strongest predictors of MBL infections. 25 Once infected, these patients are at considerable risk of mortality. Two studies conducted in patients with bloodstream infections in Athens, Greece found that 23.9–32.1% of patients died within 14 days following infection with VIM-producing K. pneumoniae .…”

“… 26 , 27 Another study conducted in a hospital in Southern India looked at 101 patients with bloodstream infections caused by NDM-producing Enterobacterales and found a mortality rate of 33.7%. 25 de Jager et al examined just hospital-associated infections (detected >48 hours after admission) caused by NDM-producers in an ICU in South Africa and observed mortality rates of 55.3%. 28 More recently, a study conducted in Italy and Greece included 102 patients with bloodstream infections caused by NDM- or VIM-producing Enterobacterales and found an overall mortality rate of 31.4%.…”