Prevalence, Risk Factors, Treatment Outcome and Molecular Epidemiology of Gastrointestinal Carbapenem-Resistant <i>Klebsiella Pneumoniae</i> from Infections in China

Abstract

Background: Carbapenem-resistant K. pneumoniae (CRKP) is the leading cause of hospital infections. The prevalence of CRKP in human and the risk factors that predispose occurrence of CRKP infections need to be determined. Methods: We conducted a retrospective, cross-sectional study of K. pneumoniae strains collected in a hospital in Zhejiang Province, China, from Jan 2014 to Dec 2017. The strains were characterized by antimicrobial susceptibility tests and whole genome sequencing. Then we investigated risk factors of CRKP infections and depicted the likely disease outcomes. Findings: 804 patients tested positive for intestinal CRKP or carbapenem susceptible strains (CSKP) in total. Ninety-seven patients were positive for both intestinal and extra-intestinal CRKP and had significantly (P<0.001) higher percentage of death (12.4%) and discharge against medical advice (DAMA) (27.8%) than those who only harbored intestinal CRKP and intestinal CSKP strains. The virulence factor Yersiniabactin-9 could increase the risk of death and DAMA by 4.6 times (95% CI: 1.8-11.7). Statistically significant risk factors associated with intestinal CRKP infections included the use of urinary catheter (OR=4.8, 95% CI 1.7-13.5), artificial lung ventilation (OR=4.1, 95% CI 2.3-7.3) during the hospitalization and exposure to tigecycline (OR=1.5, 95% CI 1.0-2.3) three months prior to hospital admission. The prevalence rates of human intestinal ST11-K64 CRKP strains has been increasing in the past few years. Interpretation: These data confirm that K. pneumoniae colonization in human gut is a significant risk factor for intestinal infection. Screening for K. pneumoniae colonization upon hospital admission could limit the risk of development of infection in patients and transmission to others in the same ward. Funding: This work was supported by the National Natural Science Foundation of China (No. 81772250, 81861138052) and Research Impact Fund of Hong Kong Research Grants Council (No. 8790002). Declaration of Interest: The authors have declared that no competing interest exists. Ethical Approval: Ethical approval (No. 2020-319) was given by SAHZU.