Community-onset carbapenem-resistant Klebsiella pneumoniae urinary tract infections in infancy following NICU hospitalisation

2017 ◽  
Vol 13 (5) ◽  
pp. 495.e1-495.e6 ◽  
Author(s):  
Eleni Vergadi ◽  
Maria Bitsori ◽  
Sofia Maraki ◽  
Emmanouil Galanakis
Keyword(s):  
Urinary Tract ◽  
Klebsiella Pneumoniae ◽  
Urinary Tract Infections ◽  
Carbapenem Resistant ◽  
Tract Infections ◽  
Community Onset

scholarly journals Clinical and Economic Impact of Community-Onset Urinary Tract Infections Caused by ESBL-Producing Klebsiella pneumoniae Requiring Hospitalization: An Observational Cohort Study

2021 ◽  
Author(s):  
Dawid Rozenkiewicz ◽  
Erika Esteve-Palau ◽  
Mar Arenas-Miras ◽  
Santiago Grau ◽  
Xavier Duran ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Cohort Study ◽  
Urinary Tract ◽  
Klebsiella Pneumoniae ◽  
Economic Impact ◽  
Urinary Tract Infections ◽  
Esbl Production ◽  
Adequate Treatment ◽  
Tract Infections ◽  
Community Onset

Objective: To analyze the clinical and economic impact of community-onset urinary tract infections (UTI) caused by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae requiring hospitalization. Methods: A retrospective cohort study included all adults with UTI caused by K. pneumoniae admitted to a tertiary care hospital in Barcelona, Spain, between 2011 and 2015. Demographic, clinical and economic data were analyzed. Results: One hundred and seventy-three episodes of UTI caused by K. pneumoniae were studied; 112 were non-ESBL-producing and 61 ESBL-producing. Multivariate analysis identified ESBL production, acute confusional state associated with UTI, shock, and time to adequate treatment as risk factors for clinical failure during the first 7 days. Economic analysis showed differences between ESBL-producing and non-ESBL-producing K. pneumoniae for the total cost of hospitalization per episode (mean 6,718 € vs 3,688 € respectively). Multivariate analysis of the higher costs of UTI episodes found statistically significant differences for ESBL production and time to adequate treatment. Conclusion: UTI caused by ESBL-producing K. pneumoniae requiring hospitalization, and time to adequate antimicrobial therapy are associated with worse clinical and economic outcomes.

scholarly journals Risk Factors for Amoxicillin-Clavulanate Resistance in Community-Onset Urinary Tract Infections Caused by Escherichia coli or Klebsiella pneumoniae: The Role of Prior Exposure to Fluoroquinolones

Antibiotics ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 582
Author(s):  
Javier Martínez-Casanova ◽  
Silvia Gómez-Zorrilla ◽  
Nuria Prim ◽  
Agustina Dal Molin ◽  
Daniel Echeverría-Esnal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Urinary Tract ◽  
Klebsiella Pneumoniae ◽  
Urinary Tract Infections ◽  
E Coli ◽  
Amoxicillin Clavulanate ◽  
Tract Infections ◽  
Community Onset ◽  
Urinary Isolates

Background: High rates of amoxicillin-clavulanate (AMC) resistance among Enterobacterales isolated from urinary tract infections (UTIs) were observed in our area. The aim of this study was to identify risk factors associated with AMC resistance in patients with community-onset UTI in emergency departments (EDs). Methods: A retrospective study was performed of all ED patients with positive urine cultures for Escherichia coli or Klebsiella pneumoniae in a Spanish tertiary-care hospital. Results: 330 urine cultures in all were included: 261 (79.1%) for E. coli and 69 (20.90%) for K. pneumonia. Rates of AMC resistance were 14.94% and 34.78%, respectively. UTI was clinically confirmed in 212 (64.24%) cases. Previous antimicrobial exposure was independently associated with AMC resistance development in E. coli and K. pneumoniae urinary isolates (OR = 2.94, 95% CI = 1.55–5.58). Analyses of infected patients revealed that previous exposure to fluoroquinolones (OR = 3.33, 95% CI = 1.10–10.12, p = 0.034) and to AMC (OR = 5.68, 95% CI = 1.97–16.44, p = 0.001) was significantly associated with isolation of AMC-resistant strains. Conclusions: Prior antibiotic exposure, particularly to AMC or fluoroquinolones, was the only independent risk factor associated with development of AMC resistance in E. coli and K. pneumoniae urinary isolates from patients attending the ED.

scholarly journals Clinical and Economic Impact of Community-Onset Urinary Tract Infections Caused by ESBL-Producing Klebsiella pneumoniae Requiring Hospitalization in Spain: An Observational Cohort Study

Antibiotics ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 585
Author(s):  
Dawid Rozenkiewicz ◽  
Erika Esteve-Palau ◽  
Mar Arenas-Miras ◽  
Santiago Grau ◽  
Xavier Duran ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Cohort Study ◽  
Urinary Tract ◽  
Klebsiella Pneumoniae ◽  
Economic Impact ◽  
Urinary Tract Infections ◽  
Esbl Production ◽  
Adequate Treatment ◽  
Tract Infections ◽  
Community Onset

Objective: To analyze the clinical and economic impact of community-onset urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae requiring hospitalization. Methods: A retrospective cohort study that included all adults with a UTI caused by K. pneumoniae that were admitted to a tertiary care hospital in Barcelona, Spain, between 2011 and 2015. Demographic, clinical, and economic data were analyzed. Results: One hundred and seventy-three episodes of UTIs caused by K. pneumoniae were studied; 112 were non-ESBL-producing and 61 were ESBL-producing. Multivariate analysis identified ESBL production, acute confusional state associated with UTI, shock, and the time taken to obtain adequate treatment as risk factors for clinical failure during the first seven days. An economic analysis showed differences between ESBL-producing and non-ESBL-producing K. pneumoniae for the total cost of hospitalization per episode (mean EUR 6718 vs EUR 3688, respectively). Multivariate analysis of the higher costs of UTI episodes found statistically significant differences for ESBL production and the time taken to obtain adequate treatment. Conclusion: UTIs caused by ESBL-producing K. pneumoniae requiring hospitalization and the time taken to obtain adequate antimicrobial therapy are associated with worse clinical and economic outcomes.

scholarly journals Activity of Meropenem-Vaborbactam against Carbapenem-Resistant Enterobacteriaceae in a Murine Model of Pyelonephritis

2017 ◽  
Vol 62 (1) ◽  
Author(s):  
William J. Weiss ◽  
Mark E. Pulse ◽  
Phung Nguyen ◽  
Kelly Peterson ◽  
Jessica Silva ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Klebsiella Pneumoniae ◽  
Urinary Tract Infections ◽  
Bacterial Killing ◽  
Gram Negative ◽  
Content Type ◽  
Highly Active ◽  
Carbapenem Resistant ◽  
Tract Infections ◽  
Carbapenem Resistant Enterobacteriaceae

ABSTRACT The recently approved combination of meropenem and vaborbactam (Vabomere) is highly active against Gram-negative pathogens, especially Klebsiella pneumoniae carbapenemase (KPC)-producing, carbapenem-resistant Enterobacteriaceae. We evaluated the efficacy of meropenem-vaborbactam against three clinically relevant isolates in a murine pyelonephritis model. The data indicate that the combination of meropenem and vaborbactam significantly increased bacterial killing compared to that with the untreated controls. These data suggest that this combination may have utility in the treatment of complicated urinary tract infections due to KPC-producing, carbapenem-resistant Enterobacteriaceae.

scholarly journals Διερεύνηση νέων β-λακταμασών σε στελέχη gram-αρνητικών βακτηρίων στην κοινότητα

2011 ◽  
Author(s):  
Αγγελική Πούλου
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Health Care Facilities ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Plasmid Analysis ◽  
Previous Hospitalization ◽  
Tract Infections ◽  
Community Onset

The aim of the study was to investigate the dissemination in the community of carbapenem-resistant gram-negative bacteria and the mechanisms of acquired resistance.Patients who were referred to the outpatient department of Serres General Hospital with community-onset infections due to carbapenem-resistant gram-negative bacteria during a 3 year period (2005-2008) were included in this study. The selected isolates were tested by determination of agar dilution MICs, phenotypic carbapenemase testing and molecular typing methods. PCR and sequencing analyses were employed for identification of bla genes and mapping of the integron carrying the metallo-β-lactamase (MBL) gene. The location of the MBL allele was investigated by mating experiments, plasmid analysis, and hybridization of the Southern-blotted plasmid extract with a blaVIM probe. The demographic and clinical characteristics of the outpatients were prospectively collected.During the study period 12 Proteus mirabilis, 97 Pseudomonas aeruginosa and 24 Klebsiella pneumoniae isolates with reduced susceptibility to imipenem and/or meropenem were recovered from urinary tract infections of 12, 45 and 12 outpatients, respectively. As many as 64 of the outpatients had a history of previous hospitalization or visit to the healthcare facilities in the preceding year while the remaining 5 outpatients with urinary tract infections due to P. aeruginosa carbapenem-resistant isolates had not been hospital admission in the preceding year.In 18 outpatients infected with P. aeruginosa and 6 outpatients infected with K. pneumoniae the carbapenem-resistant organisms caused recurrent community-onset infections, while in three outpatients P. aeruginosa isolates were also implicated in community-onset bacteremic episodes. Diabetes mellitus, prostatic hyperplasia and infection with an MBL-producing strain during a previous hospitalization were significantly associated with recurrent infections in the community setting.Recurrent infections were not detected among patients infected with MBL-producing P. mirabilis isolates. Among P. mirabilis isolates imipenem, meropenem and ertapenem MICs ranged from 32 to >128 mg/L, 1 to 8 mg/L and 0.5 to 4 mg/L, respectively. The isolates originated from the same clonal strain and harbored a blaVIM-1 gene in a common integron structure. Conjugation experiments, plasmid analysis and hybridization assays indicated the chromosomal location of blaVIM-1 gene. All 45 single-patient P. aeruginosa isolates harbored the blaVIM-2 MBL gene in a common class 1 integron structure. They belonged to one predominant pulsed-field gel electrophoresis type and three sporadically detected types; two of the sporadic clonal types were identified among outpatients without previous exposure to health care facilities, while the predominant clonal type was also identified to cause infections in hospitalized patient. The integron carrying the MBL gene was located on the bacterial chromosome.For the K. pneumoniae isolates imipenem, meropenem and ertapenem MICs ranged from 8 to 64mg/L, 4 to 32mg/L and 8 to 128mg/L, respectively. All studied isolates as well as those two recovered during previous hospitalization belonged to a single PFGE clone. They harbored a plasmid-mediated blaVIM-1 gene in an integron structure that has been previously described among clinical isolates from Greek hospitals.This is the first study to document the dissemination of MBL-producing P. mirabilis, P. aeruginosa and K. pneumoniae isolates in the community. Present clinical and molecular data provided evidence that MBL-producing strains could easily disseminated in the community from patients colonized during a previous hospitalization. Increased awareness and intensified infection control practices in the hospital as well as the community setting are the keys to curtailing the spread of these alarming carbapenem resistant pathogens.

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