Risk factors for developing clinical infection with carbapenem-resistant Klebsiella pneumoniae in hospital patients initially only colonized with carbapenem-resistant K pneumoniae

Borer, Abraham; Saidel-Odes, Lisa; Eskira, Seada; Nativ, Ronit; Riesenberg, Klaris; Livshiz–Riven, Ilana; Schlaeffer, Francisc; Sherf, Michael; Peled, Nechama

doi:10.1016/j.ajic.2011.05.022

Cited by 191 publications

(162 citation statements)

References 24 publications

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“…in our study. Tracheostomy, mechanical ventilation, hemodialysis, urinary catheter, and immunspressive therapy, which were found to be significant risk factors in a univarite analysis, were similar to the findings of other studies [14,17,18].…”

Section: Discussionsupporting

confidence: 79%

“…We did no see this finding in other articles in the literature. Recently, Borer et al reported from Israel that the presence of a gastric ulcer was associated with the carbapenem-resistant Klebsiella pneumoniae infection [17]. It can be speculated that the use of H2 receptor antagonists decreases gastric acidity and leads to colonization of carbapenem-resistant Klebsiella spp.…”

Section: Discussionmentioning

confidence: 99%

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Emergence of carbapenem-resistant Klebsiella spp. infections in a Turkish university hospital: epidemiology and risk factors

Dizbay

Tunçcan

Karaşahin

et al. 2014

J Infect Dev Ctries

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Introduction: Risk factors for nosocomial carbapenem-resistant Klebsiella spp. (CRK) infections were analyzed in this study. Methodology: The incidence, clinical characteristics, risk factors, antimicrobial susceptibility, and outcomes of CRK infections during a seven-year period (2004)(2005)(2006)(2007)(2008)(2009)(2010) were retrospectively analyzed. Results: A total of 720 patients were included in the study. Carbapenem resistance among Klebsiella spp. was significantly increased between 2003 and 2007 (p < 0.001). CRK strains were mostly isolated from intensive care units (ICUs) (p < 0.001). Using imipenem and cefoperazone-sulbactam within the prior three months, staying in ICU, receiving immunspressive therapy, receiving H2 receptor antagonists, having a tracheostomy, using mechanical ventilation, hemodialysis, and having a urinary catheter were found to be significant risk factors for carbapenem-resistant Klebsiella spp. infections. In a multivariate analysis, previously using imipenem (OR 3.35; CI 1.675-6.726, p < 0.001), staying in ICU (OR 3.36;; p = 0.022), and receiving H2 receptor antagonist (OR 4.49; 95% CI 1.011-19.951; p = 0.048) were independently associated with carbapenem resistance. Respiratory tract infections were the most common nosocomial infections. Attack mortality rate was significantly higher in patients infected with CRK strains (p < 0.001). CRK strains showed significantly higher resistance rates to other antibiotics. Conclusions: The emergence and rapid spread of CRK strains in our hospital is worrisome. The patients in the ICU are at the highest risk for the acquisition of CRK strains. High resistant rates to other antibiotics except colistin and tigecycline limit therapeutic options, and increase mortality rates.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Emergence of carbapenem-resistant Klebsiella spp. infections in a Turkish university hospital: epidemiology and risk factors

Dizbay

Tunçcan

Karaşahin

et al. 2014

J Infect Dev Ctries

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“…As in ours, only a few studies have addressed progression to infection among colonized patients with CPE, using the recovery from clinical sites as a marker for infection. [6][7][8] Interestingly, our results were similar to these studies, mainly in relation to the incidence rate of infections among colonized patients and the predominance of KPC-2-KP among the CPE isolates. On the other hand, in these studies, no data on polymyxin B resistance was reported.…”

supporting

confidence: 80%

Emergence of Infections due to a Polymyxin B–Resistant KPC-2-Producing Klebsiella pneumoniae in Critically Ill Patients: What Is the Role of a Previous Colonization?

Perez

Dias

2016

Infect. Control Hosp. Epidemiol.

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“…The frequent use of carbapenems, however, combined with the transmissibility of resistance determinants mediated by plasmids, transposons and gene cassettes, has contributed to the increase of carbapenem resistance by Enterobacteriaceae 2,3 . In countries such as the United States, Israel,Germany and Greece, carbapenemase-producing Enterobacteriaceae (CPE) had emerged and the dissemination of these multidrug-resistant pathogens had become a problem in clinical care of patients and in public health [4][5][6][7] . Invasive infections with these organisms have been associated with high rates of morbidity and mortality, due to their resistance to most available antimicrobial agents [8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

Characteristics and management of Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemase in a tertiary hospital

Pang¹,

Jia²,

Song³

et al. 2016

Afr H. Sci.

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Background: The emergence of Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemases is rare. We report an occurrence of Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemases in a Chinese tertiary care hospital from November 2010 to December 2012. Methods: The clinical characteristics of 30 patients were described. The genetic relationship of isolates was determined by pulsed-field gel electrophoresis (PFGE). Carbapenemases were detected by modified Hodge test (MHT) and polymerase chain reactions (PCRs). Amplicons were sequenced and blasted to determine the genotype. Results: Most infected patients were from intensive care unit and had complex and serious underlying illnesses requiring mechanical ventilation. PFGE revealed that Klebsiella pneumoniae showed two major PFGE types. Two Klebsiella oxytoca had an indistinguishable PFGE pattern, while four Enterobacter cloacae were different strains. The sequencing studies showed Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemase in the 23 infected patients. The majority of patients had infections with the carbapenemase-producing Enterobacteriaceae (CPE) strain, most were successfully treated with a range of antibiotics and discharged. Conclusion: It is important to maintain a high index of suspicion to screen for carbapenemase-producing Enterobacteriaceae strains. Rapid identification of these strains and implementation of stringent procedures are the key to prevent major outbreaks in a hospital setting.

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Risk factors for developing clinical infection with carbapenem-resistant Klebsiella pneumoniae in hospital patients initially only colonized with carbapenem-resistant K pneumoniae

Cited by 191 publications

References 24 publications

Emergence of carbapenem-resistant Klebsiella spp. infections in a Turkish university hospital: epidemiology and risk factors

Emergence of carbapenem-resistant Klebsiella spp. infections in a Turkish university hospital: epidemiology and risk factors

Emergence of Infections due to a Polymyxin B–Resistant KPC-2-Producing Klebsiella pneumoniae in Critically Ill Patients: What Is the Role of a Previous Colonization?

Characteristics and management of Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemase in a tertiary hospital

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