Risk factors for mortality among carbapenem-resistant enterobacteriaceae carriers with focus on immunosuppression

Bar-Yoseph, Haggai; Cohen, Nadav; Korytny, Alexander; Andrawus, Elias; Dar, Razi Even; Geffen, Yuval; Hussein, Khetam

doi:10.1016/j.jinf.2018.10.003

Cited by 15 publications

(15 citation statements)

References 21 publications

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“…These antibiotics can be hydrolyzed by the production of extended-spectrum beta-lactamases (ESBL) and carbapenemases [2]. Carbapenem-resistant Enterobacteriaceae (CRE) is known to cause a variety of nosocomial infections that are associated with high mortality rates [3, 4]. Many CRE-associated genes have been identified, including the endemic Klebsiella pneumoniae carbapenemases (KPCs) and the New Delhi Metallo-beta-lactamases (NDMs) [3, 5].…”

Section: Introductionmentioning

confidence: 99%

“…Carbapenem-resistant Enterobacteriaceae (CRE) is known to cause a variety of nosocomial infections that are associated with high mortality rates [3, 4]. Many CRE-associated genes have been identified, including the endemic Klebsiella pneumoniae carbapenemases (KPCs) and the New Delhi Metallo-beta-lactamases (NDMs) [3, 5]. Rapid identification and reporting of such markers could aid in minimizing the horizontal transfer of these genes to other bacterial species and ultimately preventing the spread of antibiotic resistance [6, 7].…”

Section: Introductionmentioning

confidence: 99%

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First report of Klebsiella quasipneumoniae harboring blaKPC-2 in Saudi Arabia

Hala

Antony

Alshehri

et al. 2019

Antimicrob Resist Infect Control

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BackgroundNosocomial infections caused by multi-drug resistant Enterobacteriaceae are a global public health threat that ought to be promptly identified, reported, and addressed accurately. Many carbapenem-resistant Enterobacteriaceae-associated genes have been identified in Saudi Arabia but not the endemic Klebsiella pneumoniae carbapenemases (KPCs), which are encoded by blaKPC-type genes. KPCs are known for their exceptional spreading potential.MethodsWe collected n = 286 multi-drug resistant (MDR) Klebsiella spp. isolates as part of screening for resistant patterns from a tertiary hospital in Saudi Arabia between 2014 and 2018. Antimicrobial susceptibility testing was carried out using both VITEK II and the broth microdilution of all collected isolates. Detection of resistance-conferring genes was carried out using Illumina whole-genome shotgun sequencing and PacBio SMRT sequencing protocols.ResultsA Carbapenem-resistant Enterobacteriaceae (CRE) Klebsiella quasipneumoniae subsp. similipneumoniae strain was identified as a novel ST-3510 carrying a blaKPC-2 carbapenemase encoding gene. The isolate, designated as NGKPC-421, was obtained from shotgun Whole Genome Sequencing (WGS) surveillance of 286 MDR Klebsiella spp. clinical isolates. The NGKPC-421 isolate was collected from a septic patient in late 2017 and was initially misidentified as K. pneumoniae. The sequencing and assembly of the NGKPC-421 genome resulted in the identification of a putative ~ 39.4 kb IncX6 plasmid harboring a blaKPC-2 gene, flanked by transposable elements (ISKpn6-blaKPC-2–ISKpn27).ConclusionThis is the first identification of a KPC-2-producing CRE in the Gulf region. The impact on this finding is of major concern to the public health in Saudi Arabia, considering that it is the religious epicenter with a continuous mass influx of pilgrims from across the world. Our study strongly highlights the importance of implementing rapid sequencing-based technologies in clinical microbiology for precise taxonomic classification and monitoring of antimicrobial resistance patterns.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

First report of Klebsiella quasipneumoniae harboring blaKPC-2 in Saudi Arabia

Hala

Antony

Alshehri

et al. 2019

Antimicrob Resist Infect Control

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“…Second, carbapenem resistance in non-fermenters usually stems from a combination of beta-lactamases, porin mutations and efflux pump overexpression, conferring reduced susceptibility to antibiotics and implying fewer treatment options and more treatment failure [29]. Systemic infection or organ failure is a surrogate marker of critical illness which has been widely reported as a predictor of poorer outcome [21,22,27,30]. Aggressive therapy and infection prevention and control measures should be initiated rapidly in this population.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of and risk factors for mortality due to carbapenemase-producing organisms (CPO) in healthcare facilities

Zhao

Kennedy

Perry

et al. 2021

Journal of Hospital Infection

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Summary Background Carbapenemase-producing organisms (CPO) have been largely responsible for the extensive spread of carbapenem resistance, and their prevalence is increasing in many parts of the world. Aim To evaluate clinical and molecular epidemiology and mortality associated with CPO among patients. Methods All CPO from clinical and long-term healthcare surveillance cultures across Scotland in 2003–2017 were reviewed retrospectively. Polymerase chain reaction was used to detect genes coding for carbapenemases. A generalized linear mixed model was used to identify risk factors for mortality. Findings In total, 290 individuals with CPO were identified. The overall incidence increased over time ( P <0.001) from 0.02 to 1.38 per 100,000 population between 2003 and 2017. A total of 243 distinct CPO isolates were obtained from 269 isolations in 214 individuals with available metadata. The majority of the isolates were Enterobacterales (206/243, 84.8%), and Klebsiella pneumoniae (65/206, 31.6%) and Enterobacter cloacae (52/206, 25.2%) were the most common species. VIM (75/243, 30.9%) and NDM (56/243, 23.0%) were the most common carbapenemases. The crude 30-day mortality rate was 11.8% (25/211), while the case fatality rate was 5.7% (12/211). Age >60 years [adjusted odds ratio (aOR) 3.36, 95% confidence interval (CI) 1.06–10.63; P =0.033], presence of non-fermenters (aOR 4.88, 95% CI 1.64–14.47; P =0.005), and systemic infection or organ failure (aOR 4.21, 95% CI 1.38–12.81; P =0.032) were independently associated with 30-day mortality. Conclusion The incidence of CPO in Scotland is low but increasing. Awareness is required that inpatients aged >60 years, patients with systemic infection or organ failure, and patients presenting with non-fermenters are at higher risk of death from CPO.

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“…In a previous study on the risk factors of CRE colonization, immunologically compromised state was reported as a factor of increasing risk for both CRE infection and mortality [5]. According to another study, risk factors for CRE colonization include the administration of antibiotics and the use of central line devices [6].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Risk Factors for Carbapenem-Resistant Enterobacteriaceae Colonization in Patients with Stroke

et al. 2019

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The prevalence and risk factors of carbapenem-resistant Enterobacteriaceae (CRE) colonization in stroke patients within the first 6 months were studied for the first time.• Antibiotic intake and duration and intensive care unit (ICU) admission were independent risk factors of CRE colonization in stroke patients within the first 6 months. • This study suggests preventing post-stroke infections and, if possible, reducing ICU admissions and preventing CRE transmission in all stroke patients admitted to the ICU.

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Risk factors for mortality among carbapenem-resistant enterobacteriaceae carriers with focus on immunosuppression

Cited by 15 publications

References 21 publications

First report of Klebsiella quasipneumoniae harboring blaKPC-2 in Saudi Arabia

First report of Klebsiella quasipneumoniae harboring blaKPC-2 in Saudi Arabia

Epidemiology of and risk factors for mortality due to carbapenemase-producing organisms (CPO) in healthcare facilities

Prevalence and Risk Factors for Carbapenem-Resistant Enterobacteriaceae Colonization in Patients with Stroke

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