scholarly journals Bloodstream Infections caused by Klebsiella pneumoniae and Serratia marcescens isolates co-harboring NDM-1 and KPC-2

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Taniela Bes ◽  
Debora Nagano ◽  
Roberta Martins ◽  
Ana Paula Marchi ◽  
Lauro Perdigão-Neto ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Serratia Marcescens ◽  
Low Income ◽  
Phenylboronic Acid ◽  
Case Series ◽  
Bloodstream Infections ◽  
Surgical Patient ◽  
Hematopoietic Stem ◽  
Molecular Tests ◽  
Carbapenem Resistant

AbstractCarbapenem-resistant Enterobacteriaceae are a worldwide health problem and isolates carrying both blaKPC-2 and blaNDM-1 are unusual. Here we describe the microbiological and clinical characteristics of five cases of bloodstream infections (BSI) caused by carbapenem-resistant Klebsiella pneumoniae and Serratia marcescens having both blaKPC-2 and blaNDM-1. Of the five blood samples, three are from hematopoietic stem cell transplantation patients, one from a renal transplant patient, and one from a surgical patient. All patients lived in low-income neighbourhoods and had no travel history. Despite antibiotic treatment, four out of five patients died. The phenotypic susceptibility assays showed that meropenem with the addition of either EDTA, phenylboronic acid (PBA), or both, increased the zone of inhibition in comparison to meropenem alone. Molecular tests showed the presence of blaKPC-2 and blaNDM-1 genes. K. pneumoniae isolates were assigned to ST258 or ST340 by whole genome sequencing. This case-series showed a high mortality among patients with BSI caused by Enterobacteriae harbouring both carbapenemases. The detection of carbapenemase-producing isolates carrying both blaKPC-2 and blaNDM-1 remains a challenge when using only phenotypic assays. Microbiology laboratories must be alert for K. pneumoniae isolates producing both KPC-2 and NDM-1.

scholarly journals Bloodstream Infections caused by Klebsiella pneumoniae and Serratia marcescens isolates co-harboring NDM-1 and KPC-2.

2020 ◽  
Author(s):  
Taniela Bes ◽  
Debora Nagano ◽  
Roberta Martins ◽  
Ana Paula Marchi ◽  
Lauro Perdigão Neto ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Serratia Marcescens ◽  
Low Income ◽  
Phenylboronic Acid ◽  
Case Series ◽  
Bloodstream Infections ◽  
Surgical Patient ◽  
Hematopoietic Stem ◽  
Molecular Tests ◽  
Carbapenem Resistant

Abstract Carbapenem-resistant Enterobacteriaceae are a worldwide health problem and isolates carrying both blaKPC-2 and blaNDM-1 are unusual. Here we describe the microbiological and clinical characteristics of five cases of bloodstream infections (BSI) caused by carbapenem-resistant Klebsiella pneumoniae and Serratia marcescens having both blaKPC-2 and blaNDM-1. Of the five blood samples, three are from hematopoietic stem cell transplantation patients, one from a renal transplant patient, and one from a soft tissue surgical patient. All patients lived in low-income neighbourhoods and had no travel history. Despite antibiotic treatment, four of five patients died. The phenotypic susceptibility assays showed that meropenem added either EDTA, phenylboronic acid (PBA) or both, increased the zone of inhibition in comparison to meropenem alone. Molecular tests showed the presence of blaKPC-2 and blaNDM-1 genes. K. pneumoniae isolates were assigned to ST258 or ST340 by whole genome sequencing. This case-series showed a high mortality among patients with BSI caused by Enterobacteriae harbouring both carbapenemases. The detection of carbapenemase-producing isolates carrying both blaKPC-2 and blaNDM-1 remains a challenge when using only phenotypic assays. Microbiology laboratories must be alert for K. pneumoniae isolates producing both KPC-2 and NDM-1.

scholarly journals Bloodstream Infections caused by Klebsiella pneumoniae and Serratia marcescens isolates co-harboring NDM-1 and KPC-2.

2020 ◽  
Author(s):  
Taniela Bes ◽  
Debora Nagano ◽  
Roberta Martins ◽  
Ana Paula Marchi ◽  
Lauro Perdigão Neto ◽  
...  
Keyword(s):  
Serratia Marcescens ◽  
Low Income ◽  
Case Series ◽  
Bloodstream Infections ◽  
Surgical Patient ◽  
Hematopoietic Stem ◽  
Travel History ◽  
Molecular Tests ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Carbapenem-resistant Enterobacteriaceae is a worldwide health problem, however isolates carrying both blaKPC-2 and blaNDM-1 are unusual. Here we describe microbiological and clinical characteristics of five cases of bloodstream infection (BSI) caused by carbapenem-resistant Klebsiella pneumoniae and Serratia marcescens co-harboring blaKPC-2 and blaNDM-1.Of the five blood culture isolates, three from are from hematopoietic stem cell transplantation patients, one from a renal transplant patient, and one from a soft tissue surgical patient. All patients lived in low-income neighborhoods and had no travel history. Despite antibiotic treatment, four of five patients died. The phenotypic assays showed that Meropenem added with either EDTA, PA or both showed increased zone of inhibition in comparison to Meropenem alone. Molecular tests confirmed blaKPC-2 and blaNDM-1 genes, the K. pneumoniae were assigned as ST258 and ST340 by Whole Genome Sequencing.This case-series showed high mortality of BSI caused by Enterobacteria coproducing KPC-2 and NDM-1. The detection of samples co-harboring blaKPC-2 and blaNDM-1 remains unsatisfactory with phenotypic assay. Routine microbiology laboratories must be on alert for samples co-harboring these mechanisms.

scholarly journals Bloodstream Infections caused by Klebsiella pneumoniae and Serratia marcescens isolates co-harboring NDM-1 and KPC-2.

2020 ◽  
Author(s):  
Taniela Bes ◽  
Debora Nagano ◽  
Roberta Martins ◽  
Ana Paula Marchi ◽  
Lauro Perdigão Neto ◽  
...  
Keyword(s):  
Serratia Marcescens ◽  
Low Income ◽  
Renal Transplant Patient ◽  
Bloodstream Infections ◽  
Surgical Patient ◽  
Hematopoietic Stem ◽  
Travel History ◽  
Molecular Tests ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Carbapenem-resistant Enterobacteriaceae is a worldwide health problem, however isolates carrying both blaKPC-2 and blaNDM-1 are unusual. Here we describe microbiological and clinical characteristics of five cases of bloodstream infection (BSI) caused by carbapenem-resistant K lebsiella pneumoniae and Serratia marcescens co-harboring blaKPC-2 and blaNDM-1.Of the five blood culture isolates, three from are from hematopoietic stem cell transplantation patients, one from a renal transplant patient, and one from a soft tissue surgical patient. All patients lived in low-income neighborhoods and had no travel history. Despite antibiotic treatment, four of five patients died. The phenotypic assays showed that Meropenem added with either EDTA, PA or both showed increased zone of inhibition in comparison to Meropenem alone. Molecular tests confirmed blaKPC-2 and blaNDM-1 genes, the K. pneumoniae were assigned as ST258 and ST340 by Whole Genome Sequencing.

Disease Severity Is an Independent Risk Factor of Mortality and Outcomes in Critically Ill Patients With Carbapenem-resistant Klebsiella Pneumoniae Bloodstream Infections: a 5-year Retrospective Analysis

2021 ◽  
Author(s):  
Yuzhen Qiu ◽  
Wen Xu ◽  
Yunqi Dai ◽  
Ruoming Tan ◽  
Jialin Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Klebsiella Pneumoniae ◽  
Critically Ill Patients ◽  
Bloodstream Infections ◽  
Polymyxin B ◽  
Mortality Rates ◽  
Carbapenem Resistant ◽  
All Cause Mortality ◽  
Independent Risk Factors

Abstract Background: Carbapenem-resistant Klebsiella pneumoniae bloodstream infections (CRKP-BSIs) are associated with high morbidity and mortality rates, especially in critically ill patients. Comprehensive mortality risk analyses and therapeutic assessment in real-world practice are beneficial to guide individual treatment.Methods: We retrospectively analyzed 87 patients with CRKP-BSIs (between July 2016 and June 2020) to identify the independent risk factors for 28-day all-cause mortality. The therapeutic efficacies of tigecycline-and polymyxin B-based therapies were analyzed.Results: The 28-day all-cause mortality and in-hospital mortality rates were 52.87% and 67.82%, respectively, arising predominantly from intra-abdominal (56.32%) and respiratory tract infections (21.84%). A multivariate analysis showed that 28-day all-cause mortality was independently associated with the patient’s APACHE II score (p = 0.002) and presence of septic shock at BSI onset (p = 0.006). All-cause mortality was not significantly different between patients receiving tigecycline- or polymyxin B-based therapy (55.81% vs. 53.85%, p = 0.873), and between subgroups mortality rates were also similar. Conclusions: Critical illness indicators (APACHE II scores and presence of septic shock at BSI onset) were independent risk factors for 28-day all-cause mortality. There was no significant difference between tigecycline- and polymyxin B-based therapy outcomes. Prompt and appropriate infection control should be implemented to prevent CRKP infections.

scholarly journals Draft Genome Sequence of Carbapenem-Resistant Klebsiella pneumoniae XPY20 Collected from a Bloodstream Infection Patient

2018 ◽  
Vol 6 (21) ◽  
Author(s):  
Qiong Chen ◽  
Jia-wei Zhou ◽  
Sheng-hai Wu ◽  
Xiao-hua Meng ◽  
Dao-jun Yu ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Draft Genome ◽  
Bloodstream Infections ◽  
Mortality Rates ◽  
Resistance Mechanisms ◽  
Severe Problem ◽  
Content Type ◽  
Carbapenem Resistant ◽  
Infection Patient ◽  
Generation Sequencing

ABSTRACT Bloodstream infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) strains have been a severe problem with high clinical costs and high mortality rates. The bla KPC-2-producing CRKP strain XPY20 was collected from the blood of a patient. The genome characteristics and antimicrobial resistance mechanisms were determined using next-generation sequencing.

scholarly journals Combination Regimens for Treatment of Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infections

2016 ◽  
Vol 60 (6) ◽  
pp. 3601-3607 ◽  
Author(s):  
A. Gomez-Simmonds ◽  
B. Nelson ◽  
D. P. Eiras ◽  
A. Loo ◽  
S. G. Jenkins ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Klebsiella Pneumoniae ◽  
Active Agent ◽  
Bloodstream Infections ◽  
Individual Treatment ◽  
Beta Lactam ◽  
Content Type ◽  
Carbapenem Resistant ◽  
Extended Spectrum

Previous studies reported decreased mortality in patients with carbapenemase-producingKlebsiella pneumoniaebloodstream infections (BSIs) treated with combination therapy but included carbapenem-susceptible and -intermediate isolates, as per revised CLSI breakpoints. Here, we assessed outcomes in patients with BSIs caused by phenotypically carbapenem-resistantK. pneumoniae(CRKP) according to the number ofin vitroactive agents received and whether an extended-spectrum beta-lactam (BL) antibiotic, including meropenem, or an extended-spectrum cephalosporin was administered. We retrospectively reviewed CRKP BSIs at two New York City hospitals from 2006 to 2013, where all isolates had meropenem or imipenem MICs of ≥4 μg/ml. Univariate and multivariable models were created to identify factors associated with mortality. Of 141 CRKP BSI episodes, 23% were treated with a single active agent (SAA), 26% were treated with an SAA plus BL, 28% were treated with multiple active agents (MAA), and 23% were treated with MAA plus BL. Ninety percent of isolates had meropenem MICs of ≥16 μg/ml. Thirty-day mortality was 33% overall and did not significantly differ across the four treatment groups in a multivariable model (P= 0.4); mortality was significantly associated with a Pitt bacteremia score of ≥4 (odds ratio [OR], 7.7; 95% confidence interval [CI], 3.2 to 18.1;P= 0.1), and immunosuppression was protective (OR, 0.4; 95% CI, 0.2 to 1.0;P= 0.04). Individual treatment characteristics were also not significantly associated with outcome, including use of SAAs versus MAA (26% versus 38%,P= 0.1) or BL versus no BL (26% versus 39%,P= 0.1). In summary, in patients with CRKP BSIs caused by isolates with high carbapenem MICs, the role of combination therapy remains unclear, highlighting the need for prospective studies to identify optimal treatment regimens.

scholarly journals Outcome of carbapenem resistant Klebsiella pneumoniae bloodstream infections

2012 ◽  
Vol 18 (1) ◽  
pp. 54-60 ◽  
Author(s):  
D. Ben-David ◽  
R. Kordevani ◽  
N. Keller ◽  
I. Tal ◽  
A. Marzel ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Bloodstream Infections ◽  
Carbapenem Resistant

scholarly journals Infection control management and surveillance of carbapenem-resistant Gram-negative bacteria in hematopoietic stem cell recipients

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Claas Baier ◽  
Maleen Beck ◽  
Viktoria Panagiota ◽  
Catherina Lueck ◽  
Daniel Kharazipour ◽  
...  
Keyword(s):  
Infection Control ◽  
Acinetobacter Baumannii ◽  
Bloodstream Infections ◽  
Index Patient ◽  
Empiric Antibiotic Therapy ◽  
Gram Negative Bacteria ◽  
Hematopoietic Stem ◽  
Carbapenem Resistant ◽  
Empiric Antibiotic ◽  
Control Management

Abstract Hematopoietic stem cell transplantation (HSCT) is a curative treatment option for selected diseases of the hematopoietic system. In the context of HSCT, bloodstream infections caused by Gram-negative bacteria (GNB) significantly contribute to morbidity and mortality. Antibiotic treatment of bloodstream infections with carbapenem-resistant (CR) GNB presents a particular challenge. As a part of our infection control management, the admission of a patient who was known to be colonized with a CR Acinetobacter baumannii triggered an active weekly screening of all patients to determine the prevalence and potential transmission of CR GNB and CR Acinetobacter baumannii in particular. Over a 3 month period a total of 71 patients were regularly screened for colonization with CR GNB. Including the index patient, a total of three patients showed CR GNB colonization representing a prevalence of 4.2%. Nosocomial transmission of CR Acinetobacter baumannii or other CR GNB was not observed. However, the index patient developed a subsequent bloodstream infection with the CR Acinetobacter baumannii, therefore empiric antibiotic therapy based on the known resistance profile was initiated. A weekly prevalence screening for CR GNB might be an effective monitoring tool for potential transmission, may enhance existing infection control management concepts and may support the decision making for empiric antibiotic therapy.

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