Risk factors for KPC-producing Klebsiella pneumoniae enteric colonization upon ICU admission

Papadimitriou-Olivgeris, Matthaios; Marangos, Markos; Fligou, Fotini; Christofidou, Myrto; Bartzavali, Christina; Anastassiou, Evangelos D.; Filos, Kriton S.

doi:10.1093/jac/dks316

Cited by 94 publications

(76 citation statements)

References 18 publications

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“…Similar mechanisms might also explain why recent carbapenem therapy is predictive of KPCKP strain isolation. These drugs have been associated with carbapenem-resistant K. pneumoniae infections and/or isolation of KPCKP in other studies (16)(17)(18).…”

Section: Discussionmentioning

confidence: 97%

“…A recent review of these efforts found that the factors associated with colonization, infection, and mortality caused by these organisms vary considerably with the species and enzymatic profile of the isolate (5). Less attention has been focused specifically on KPCproducing strains of K. pneumoniae (KPCKP), and these studies have also been fairly small (17)(18)(19)(20). The reported rates of mortality related to KPCKP infections vary widely, from 22% to 72% (3,4,7,21).…”

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confidence: 99%

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Predictive Models for Identification of Hospitalized Patients Harboring KPC-Producing Klebsiella pneumoniae

Tumbarello

Trecarichi

Tumietto

et al. 2014

Antimicrob Agents Chemother

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The production of Klebsiella pneumoniae carbapenemases (KPCs) by Enterobacteriaceae has become a significant problem in recent years. To identify factors that could predict isolation of KPC-producing K. pneumoniae (KPCKP) in clinical samples from hospitalized patients, we conducted a retrospective, matched (1:2) case-control study in five large Italian hospitals. The case cohort consisted of adult inpatients whose hospital stay included at least one documented isolation of a KPCKP strain from a clinical specimen. For each case enrolled, we randomly selected two matched controls with no KPCKP-positive cultures of any type during their hospitalization. Matching involved hospital, ward, and month/year of admission, as well as time at risk for KPCKP isolation. A subgroup analysis was also carried out to identify risk factors specifically associated with true KPCKP infection. Since 2010, Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae have caused numerous outbreaks of severe nosocomial infections in the northeastern United States, Israel, Greece, and Italy, and they are now considered endemic in these areas (1-9). Not only do KPC-producing organisms hydrolyze carbapenems, but also, they are often resistant to multiple other antibiotics (7, 9-11). Consequently, they are invariably associated with high treatment failure rates (3, 4, 7).Several relatively small studies have investigated risk factors for infection and/or colonization by carbapenem-resistant isolates of K. pneumoniae and other Gram-negative bacteria (5,8,(12)(13)(14)(15)(16). A recent review of these efforts found that the factors associated with colonization, infection, and mortality caused by these organisms vary considerably with the species and enzymatic profile of the isolate (5). Less attention has been focused specifically on KPCproducing strains of K. pneumoniae (KPCKP), and these studies have also been fairly small (17)(18)(19)(20). The reported rates of mortality related to KPCKP infections vary widely, from 22% to 72% (3,4,7,21). The risk obviously depends on factors like population age and underlying disease/comorbidity profiles, which were highly heterogeneous in the studies cited above. The criteria used to distinguish true KPCKP infections and simple colonization can also influence mortality rates. The term "infection" is frequently applied to cases characterized by isolation of KPCKP from clinical specimens (rather than rectal swabs collected for screening purposes). However, the presence of KPCKP in such samples-especially sputum and urine-can also reflect simple colonization. Therefore, this definition can favor overtreatment and distorts assessments of clinical outcomes.To clarify the inpatient risk factors associated with isolation of a KPCKP strain, we conducted a large, retrospective study in five Italian hospitals, where these organisms are an increasingly frequent cause of serious disease. A subgroup analysis was also carried out to identify risk factors specifically associated with true KPCKP infection. MAT...

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Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 99%

Predictive Models for Identification of Hospitalized Patients Harboring KPC-Producing Klebsiella pneumoniae

Tumbarello

Trecarichi

Tumietto

et al. 2014

Antimicrob Agents Chemother

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“…Similar risk factors for KPC have been described (Souli et al, 2012;Correa et al, 2013). Prior studies demonstrated associations between KPC-producing K. pneumoniae infection and length of hospitalization, use of central venous catheters, ICU stay and exposure to specific broad-spectrum antimicrobial agents, such as carbapenems, cephalosporins, fluoroquinolones and penicillins (Papadimitriou-Olivgeris et al, 2012;Tumbarello et al, 2014). Despite surgery being reported as a risk factor for carbapenem-resistant K. pneumoniae infection/colonization, molecular analysis to detect carbapenemase genes was not performed in this study (Kofteridis et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

Risk factors for KPC-producing Klebsiella pneumoniae: watch out for surgery

Silva

Maciel

Sacchi

et al. 2016

Journal of Medical Microbiology

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This study describes the molecular characteristics and risk factors associated with carbapenemresistant Klebsiella pneumoniae strains. Risk factors associated with KPC-producing K. pneumoniae strains were investigated in this case-control study from May 2011 to May 2013. Bacterial identification was performed by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS). Antimicrobial susceptibility was determined by broth microdilution. Carbapenemase production was assessed by both modified Hodge test (MHT) and ertapenem hydrolysis using MALDI-TOF MS. The presence of b-lactamase-encoding genes was evaluated by PCR and DNA sequencing. Alterations in genes encoding K. pneumoniae outer membrane proteins were analysed by PCR and DNA sequencing as well as SDS-PAGE. Genetic relatedness among strains was determined by pulsed-field gel electrophoresis. This study included 94 patients. Longer hospitalisation, mechanical ventilation, catheters, and previous surgery were associated with KPC-producing K. pneumoniae. Sixty-eight strains showed resistance to carbapenems. Carbapenemase production was detected by MHT in 67 K. pneumoniae strains and by MALDI-TOF MS in 57. The presence of the bla KPC-2 gene was identified in 57 strains. The bla KPC-2 gene was not found in 11 carbapenem-resistant K. pneumoniae; instead, the bla CTX-M-1-like , bla CTX-M-2-like , bla CTX-M-8 like , bla CTX-M-14-like and bla SHV-like genes associated with OmpK35 and OmpK36 alterations were observed. Thirty-three KPC-producing K. pneumoniae strains were clonally related, and patients infected with these strains had a higher mortality rate (78.78 %). Our results show that KPC-producing K. pneumoniae was associated with several healthcare-related risk factors, including recent surgery.

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“…14,15 Few studies have evaluated risk factors for colonization or infection so far. In ICU-admitted patients, the importance of prior antibiotic exposure, prior hospitalization, severe illness and respiratory failure has been emphasized, 16,17 together with bacterial genotype and phenotype. 18 …”

Section: Epidemiologymentioning

confidence: 99%

Carbapenemase-producing Klebsiella pneumoniae in elderly frail patients admitted to medical wards

2014

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Carbapenemase-producing Klebsiella pneumoniae (CPKP) is rapidly emerging as a leading nosocomial infection in many countries, especially in Italy where it is considered endemic. In this paper we briefly summarize the main characteristics of this outbreak, focusing on its recent spread to elderly frail patients admitted to internal medicine and geriatric wards. Severity of disease, clinical complexity and a large number of comorbidities seem to be major risk factors in clinical practice, although scientific evidence is still lacking, since until now studies have been carried out mainly in intensive care settings. We also discuss the possible role of gut microbiota in CPKP colonization onset and the possible role of pre-probiotics in promoting eradication.

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Risk factors for KPC-producing Klebsiella pneumoniae enteric colonization upon ICU admission

Abstract: The high prevalence of KPC-Kp enteric carriage in ICU patients at admission dictates the importance of implementation of infection control measures and strict antibiotic policies prior to ICU transfer.

Cited by 94 publications

References 18 publications

Predictive Models for Identification of Hospitalized Patients Harboring KPC-Producing Klebsiella pneumoniae

Predictive Models for Identification of Hospitalized Patients Harboring KPC-Producing Klebsiella pneumoniae

Risk factors for KPC-producing Klebsiella pneumoniae: watch out for surgery

Carbapenemase-producing Klebsiella pneumoniae in elderly frail patients admitted to medical wards

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