Risk Factors for the Development of Colistin Resistance during Colistin Treatment of Carbapenem-Resistant Klebsiella pneumoniae Infections

Huang, Po‐Han; Chen, Wen-Yin; Chou, Sheng-Hua; Wang, Fu‐Der; Lin, Yi-Tsung

doi:10.1128/spectrum.00381-22

Cited by 9 publications

(5 citation statements)

References 30 publications

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“…Как правило, у K. pneumoniae колистин-резистентность ассоциируется с карбапенем-резистентностью. В нашем исследовании все штаммы CRKP продуцировали карбапенемазы, как и в исследовании P. Huang et al (2022); в некоторых работах продукция карбапенемаз у CRKP была ниже -73-77% [14,19,27]. Нами выявлено преобладание 2 типов карбапенемаз у CRKP -OXA-48 и NDM.…”

Section: Discussionunclassified

A pilot study of the clinical significance and outcomes of infections in the ICU caused by colistin-resistant Klebsiella pneumoniae

Sychev,

Ignatenko,

Yakovlev

et al. 2024

Vestn. anesteziol. reanimatol.

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The objective was to study the risk factors, outcomes of infections caused by colistin-resistant K. pneumonia (CRKP) and to evaluate the sensitivity of these microorganisms to antibacterial agents to determine the most adequate antibiotic therapy options.Materials and methods. Klebsiella pneumoniae strains isolated in the ICU of an acute care hospital between October 2020 and August 2022 were included in the study. Microorganisms were identified using an automatic analyzer PHOENIX. The determination of antibiotic sensitivity was studied by the method of serial micro-dilutions in agar with the determination of MIC EUCAST criteria were used to interpret sensitivity. Detection of carbapenemases was carried out by PCR. Clinical efficacy of starter therapy was evaluated as recovery/improvement and no effect.Results. The infection was characterized by a severe course in 58.9 % of patients, with SOFA scores ranging from 1 to 16 points (mean 5.8 points). 88.2 % of patients had received prior antibiotics, most commonly carbapenems. CRKP infections occurred more frequently in older men with comorbidity. The clinical efficacy of initial antibiotic therapy was 41.2 %. In 47.1 % of cases, there was no effect, which required adjustment of therapy. Excluding patients in whom it was impossible to evaluate the effect, eradication was achieved in 33.3 % of patients. 64.6 % of patients were discharged or transferred to another hospital; 6 patients died between 5 and 41 days after diagnosis of CRKP infection. Fatal outcome was more frequent in women ( p=0.042), patients with higher comorbidity index (p=0.027), in case of sepsis and/or septic shock ( p=0.011), and in earlier detection of CRKP after hospitalization ( p<0.001).Conclusion. The efficacy of initial antibiotic therapy after detection of CRKP infection has been shown to be associated with patient survival and reduced risk of mortality with an odds ratio of 3.5. We also identified risk factors for mortality in CRKP infection: comorbidity, sepsis, duration of hospitalization and female gender.

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Section: Discussionunclassified

A pilot study of the clinical significance and outcomes of infections in the ICU caused by colistin-resistant Klebsiella pneumoniae

Sychev,

Ignatenko,

Yakovlev

et al. 2024

Vestn. anesteziol. reanimatol.

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“…We found no link between colistin-resistant isolates and previous exposure to colistin [ 21 , 22 , 27 , 28 , 32 ]. However, the findings on this topic are still controversial [ 31 , 33 ]; one study found a protective effect for the use of colistin–tigecycline combination therapy [ 34 ], whereas another showed a protective effect for aminoglycosides in acquired colistin-resistant strains [ 23 ]. In our institutions, colistin is used when a CPE infection is suspected and confirmed.…”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with colistin resistance in carbapenemase-producing Enterobacterales: a multicenter study from a low-income country

Claudia,

Carmen,

Andrés

et al. 2023

Ann Clin Microbiol Antimicrob

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Purpose The aim of this study was to assess the risk factors for colistin-resistant carbapenemase-producing Enterobacterales (CR-CPE), and describe the mortality associated with this organism, in a low-income country. Methods A descriptive, observational, and prospective multicenter study was carried out in Guayaquil, Ecuador. All patients with carbapenem-resistant Enterobacterales admitted between December 2021 and May 2022 were enrolled. Infection definitions were established according to the Centers for Disease Control and Prevention (CDC) protocols. The presence of carbapenemase-producing Enterobacterales was confirmed with a multiplex PCR for blaKPC,blaNDM,blaOXA-48,blaVIM, and blaIMP genes. MCR-1 production was studied molecularly, and MLST assays were carried out. Results Out of 114 patients enrolled in the study, 32 (28.07%) had at least one positive sample for CR-CPE. Klebsiella pneumoniae ST512-KPC-3 was the most frequent microorganism isolated. Parenteral feeding, β-lactamase inhibitor use, recent hemodialysis, and renal failure were all considered independent risk factors for carrying CR-CPE. A mortality of 41.22% was detected, but we could not find any difference between colistin-resistant and colistin-susceptible CPE. MCR-1 production was not detected in any of the isolates studied. Conclusion A significant burden for CR-CPE was found in a South American country that was mainly caused by the high-risk clone K. pneumoniae ST512-KPC-3 and not mediated by mcr-1 production. Its acquisition involved parenteral feeding, β-lactamase inhibitor use, recent hemodialysis, and renal failure as independent risk factors, demonstrating the critical need for infection prevention and stewardship programs to avoid dissemination to other countries in the region.

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“…Tigecycline susceptibility was based on the US Food and Drug Administration criteria (susceptible, MIC≤2 mg/L; resistant, MIC≥8 mg/L). 12 Escherichia coli ATCC25922 and Pseudomonas aeruginosa ATCC27853 were used as quality control standards.…”

Section: Methodsmentioning

confidence: 99%

Intestinal Colonization with Carbapenem-Resistant Enterobacteriaceae in Acute Leukemia Patients: Risk Factors and Molecular Characteristics

Zhu¹,

Xu²,

Lian³

et al. 2022

IDR

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Background Carbapenem-resistant Enterobacteriaceae (CRE) colonization is associated with bacterial translocation, which can result in subsequent endogenous CRE infection. In the present study, we aim to investigate the colonization-related risk factors and molecular epidemiological characteristics of CRE in patients with acute leukemia. Methods From January 2021 to December 2021, acute leukemia patients were screened for CRE by fecal/perianal swabs. We identified the species, carbapenemase-encoding genes, and virulence genes of the colonizing strains and performed antimicrobial susceptibility tests and ERIC-PCR typing. Risk factors for CRE colonization were identified by univariate and multivariate analysis. Results We collected a total of 21 colonizing strains from 320 patients. All strains were resistant to meropenem. Klebsiella pneumoniae was the most abundant species, and ERIC-PCR typing showed low diversity. Univariate analysis showed that age, cephalosporins, penicillins, tigecyclines, and hematopoietic stem cell transplantation status were risk factors for CRE colonization; simultaneously discovered CRE strains played a dominant role in invasive infection of colonized patients. Logistic multivariate regression analysis showed that age, cephalosporins, and tigecyclines were independent risk factors for CRE intestinal colonization. Conclusion CRE colonization can increase the incidence of CRE infection in patients with acute leukemia. Early detection of CRE colonization through CRE screening is an important measure to control the spread of CRE.

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Risk Factors for the Development of Colistin Resistance during Colistin Treatment of Carbapenem-Resistant Klebsiella pneumoniae Infections

Abstract: Treatment of carbapenem-resistant Klebsiella pneumoniae (CRKP) infections is challenging due to the limited options of antibiotics. Colistin is one of the last-resort antibiotics if novel antimicrobial agents are not available.

Cited by 9 publications

References 30 publications

A pilot study of the clinical significance and outcomes of infections in the ICU caused by colistin-resistant Klebsiella pneumoniae

A pilot study of the clinical significance and outcomes of infections in the ICU caused by colistin-resistant Klebsiella pneumoniae

Risk factors associated with colistin resistance in carbapenemase-producing Enterobacterales: a multicenter study from a low-income country

Intestinal Colonization with Carbapenem-Resistant Enterobacteriaceae in Acute Leukemia Patients: Risk Factors and Molecular Characteristics

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