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Infections Caused by Carbapenemase-Producing Klebsiella pneumoniae: Microbiological Characteristics and Risk Factors

The spread of carbapenemase-producing Klebsiella pneumoniae (CPKP) worldwide is a serious problem. This retrospective, matched case–control, parallel study in a tertiary teaching hospital analyzed the microbiological and clinical characteristics of CPKP infection, focusing on the risk factors for ca...

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Autores principales: Pan, Hongying, Lou, Yaling, Zeng, Linyan, Wang, Li, Zhang, Jiajie, Yu, Wei, Qiu, Yunqing
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Mary Ann Liebert, Inc., publishers 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441289/
https://www.ncbi.nlm.nih.gov/pubmed/30810470
http://dx.doi.org/10.1089/mdr.2018.0339
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author Pan, Hongying
Lou, Yaling
Zeng, Linyan
Wang, Li
Zhang, Jiajie
Yu, Wei
Qiu, Yunqing
author_facet Pan, Hongying
Lou, Yaling
Zeng, Linyan
Wang, Li
Zhang, Jiajie
Yu, Wei
Qiu, Yunqing
author_sort Pan, Hongying
collection PubMed
description The spread of carbapenemase-producing Klebsiella pneumoniae (CPKP) worldwide is a serious problem. This retrospective, matched case–control, parallel study in a tertiary teaching hospital analyzed the microbiological and clinical characteristics of CPKP infection, focusing on the risk factors for carbapenem resistance and patient mortality. The hospital department with the highest incidence of CPKP infections was the intensive care unit. All CPKP strains examined were positive for bla(kpc-2), and 84.8% of CPKP were ST11. Hypervirulent phenotype was identified in 22.7% of the patients with CPKP, with these strains displaying a high incidence of positivity for entB, ybtS, and iutA. Multivariate conditional logistic regression analysis demonstrated that Pitt bacteremia score >4, prior stomach tube, continuous renal replacement therapy (CRRT), and previous carbapenem exposure were associated with CPKP infection. Higher albumin concentration and use of cephalosporins after diagnosis were strong prognostic factors for crude 28-day mortality. Further, high APACHE II score, CRRT, use of carbapenems after diagnosis, and bacteremia were risk factors for crude in-hospital mortality. CPKP isolates showed clonal spread and were resistant to most antibiotics, resulting in higher financial burden. Critical illness was associated with increased mortality.
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spelling pubmed-64412892019-04-01 Infections Caused by Carbapenemase-Producing Klebsiella pneumoniae: Microbiological Characteristics and Risk Factors Pan, Hongying Lou, Yaling Zeng, Linyan Wang, Li Zhang, Jiajie Yu, Wei Qiu, Yunqing Microb Drug Resist Epidemiology The spread of carbapenemase-producing Klebsiella pneumoniae (CPKP) worldwide is a serious problem. This retrospective, matched case–control, parallel study in a tertiary teaching hospital analyzed the microbiological and clinical characteristics of CPKP infection, focusing on the risk factors for carbapenem resistance and patient mortality. The hospital department with the highest incidence of CPKP infections was the intensive care unit. All CPKP strains examined were positive for bla(kpc-2), and 84.8% of CPKP were ST11. Hypervirulent phenotype was identified in 22.7% of the patients with CPKP, with these strains displaying a high incidence of positivity for entB, ybtS, and iutA. Multivariate conditional logistic regression analysis demonstrated that Pitt bacteremia score >4, prior stomach tube, continuous renal replacement therapy (CRRT), and previous carbapenem exposure were associated with CPKP infection. Higher albumin concentration and use of cephalosporins after diagnosis were strong prognostic factors for crude 28-day mortality. Further, high APACHE II score, CRRT, use of carbapenems after diagnosis, and bacteremia were risk factors for crude in-hospital mortality. CPKP isolates showed clonal spread and were resistant to most antibiotics, resulting in higher financial burden. Critical illness was associated with increased mortality. Mary Ann Liebert, Inc., publishers 2019-03-01 2019-03-08 /pmc/articles/PMC6441289/ /pubmed/30810470 http://dx.doi.org/10.1089/mdr.2018.0339 Text en © Hongying Pan et al., 2019; Published by Mary Ann Liebert, Inc. This Open Access article is distributed under the terms of the Creative Commons License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Epidemiology
Pan, Hongying
Lou, Yaling
Zeng, Linyan
Wang, Li
Zhang, Jiajie
Yu, Wei
Qiu, Yunqing
Infections Caused by Carbapenemase-Producing Klebsiella pneumoniae: Microbiological Characteristics and Risk Factors
title Infections Caused by Carbapenemase-Producing Klebsiella pneumoniae: Microbiological Characteristics and Risk Factors
title_full Infections Caused by Carbapenemase-Producing Klebsiella pneumoniae: Microbiological Characteristics and Risk Factors
title_fullStr Infections Caused by Carbapenemase-Producing Klebsiella pneumoniae: Microbiological Characteristics and Risk Factors
title_full_unstemmed Infections Caused by Carbapenemase-Producing Klebsiella pneumoniae: Microbiological Characteristics and Risk Factors
title_short Infections Caused by Carbapenemase-Producing Klebsiella pneumoniae: Microbiological Characteristics and Risk Factors
title_sort infections caused by carbapenemase-producing klebsiella pneumoniae: microbiological characteristics and risk factors
topic Epidemiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441289/
https://www.ncbi.nlm.nih.gov/pubmed/30810470
http://dx.doi.org/10.1089/mdr.2018.0339
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