Abstract
Background: The increasing prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) poses an immediate threat to treatment worldwide. This retrospective study assessed the molecular epidemiology and determined the risk factors for and outcomes of CRKP infections in a general teaching hospital in Shanghai, China.Methods: From January 2013 to July 2015, 100 consecutive unique CRKP isolates isolated from hospitalized patients were collected. Isolates were screened for antibiotic resistance genes by polymerase chain reaction and molecular typing was performed by pulsed-field gel electrophoresis (PFGE). Patients infected with CRKP comprised the case group and were compared to the control group of patients infected with carbapenem-susceptible Klebsiella pneumoniae. Therapeutic effects were compared in the CRKP infection group.Results: Among the 100 CRKP isolates, the percentages of multidrug-resistant, extensively drug-resistant (XDR), and pandrug-resistant were 50.0, 50.0, and 0%, respectively. All the CRKP isolates produced KPC-2 and could be divided into 18 PFGE clusters (A–O) and 70 subtypes. No dominant intra-hospital PFGE type was detected using a cutoff of 80% similarity. The ratio of CRKP infection to colonization was 51 to 49. Risk factors correlated with CRKP infection included pulmonary disease (p = 0.038), ICU stay (p = 0.002), invasive ventilation (p = 0.009), blood transfusion (p = 0.028), parenteral nutrition (p = 0.004), sputum suction (p = 0.006), medical history of previous hospitalization (p = 0.022), exposure to antibiotics 90 days before infection (p = 0.030), and antibiotic exposure during hospital stay including carbapenems (p = 0.013), enzyme inhibitors (p = 0.021), nitroimidazoles (p = 0.029), and glycopeptides (p = 0.000). Multivariable analysis showed that sputum suction (odds ratio 3.090, 95% confidence intervals 1.004–9.518, p = 0.049) was an independent risk factor for CRKP infections. Patients infected with CRKP with longer carbapenems treatment course (p = 0.002) showed better outcome.Conclusion: This study showed the severity of CRKP infection in eastern China. Sputum suction was an independent risk factor for CRKP infection. Prolonged duration of treatment with carbapenems benefited the patients infected with CRKP.
Highlights
Klebsiella pneumoniae (KP), one of the most commonly isolated Gram-negative bacterial pathogens in nosocomial infections, has posed a major threat to clinical and public health because of its ability to produce carbapenemases, which hydrolyze carbapenem antibiotics
To study the risk factors of patients infected by carbapenem-resistant Klebsiella pneumoniae (CRKP) infection, a stepwise matching technique was used to identify appropriate control cases from patients infected with carbapenem-susceptible Klebsiella pneumoniae (CSKP)
CRKP isolates were obtained from patients admitted to the neurosurgery ward (n = 21, 21%), surgery ward (n = 16, 16%), geriatric ward (n = 15, 15%), surgery intensive care unit (SICU) ward (n = 14, 14%), emergency ward (n = 13, 13%), outpatients (n = 10, 10%), hematology ward (n = 5, 5%), nephrology ward (n = 2, 2%), endocrine ward (n = 1, 1%), liver transplant ward (n = 1, 1%), obstetrics and gynecology ward (n = 1, 1%), and urinary surgery ward (n = 1, 1%)
Summary
Klebsiella pneumoniae (KP), one of the most commonly isolated Gram-negative bacterial pathogens in nosocomial infections, has posed a major threat to clinical and public health because of its ability to produce carbapenemases, which hydrolyze carbapenem antibiotics. Carbapenems constitute the last line of defense against infections caused by multidrugresistant (MDR) Gram-negative organisms. Bloodstream infections caused by CRKP increase the risks of treatment failure and death (Tumbarello et al, 2012). The increasing prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) poses an immediate threat to treatment worldwide. This retrospective study assessed the molecular epidemiology and determined the risk factors for and outcomes of CRKP infections in a general teaching hospital in Shanghai, China
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
