scholarly journals Emergence of meropenem/vaborbactam resistance in KPC-producing Klebsiella pneumoniae causing bloodstream infections in northern Italy, 2018

2021 ◽  
Author(s):  
Paolo Gaibani ◽  
Donatella Lombardo ◽  
Linda Bussini ◽  
Federica Bovo ◽  
Maddalena Giannella ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Clinical Outcome ◽  
Bloodstream Infection ◽  
Genomic Analysis ◽  
Bloodstream Infections ◽  
Antimicrobial Treatment ◽  
Northern Italy ◽  
Cross Resistance ◽  
Specific Mutation ◽  
Favorable Clinical Outcome

Abstract We aimed to investigate the incidence of meropenem/vaborbactam-resistance among KPC-producing Klebsiella pneumoniae (KPC-Kp) bloodstream infection in a large Italian hospital. Meropenem/vaborbactam-resistance was found in 8% (n = 5) KPC-Kp, while 5% (n = 3) strains exhibited cross-resistance to ceftazidime/avibactam. Genomic analysis revealed that meropenem/vaborbactam-resistance was associated to non-functional OmpK35 and OmpK36 porins and no specific mutation was associated to cross-resistance. No specific antimicrobial treatment was related to favorable clinical outcome, while cross-resistance was not associated to higher clinical and/or microbiological failures. Our study indicated that resistance to meropenem/vaborbactam was due to porins deficiency and is associated to reduced susceptibility both to ceftazidime/avibactam and carbapenems.

scholarly journals 908. Evaluation of Blood Culture Submission Rates in Japan

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S487-S488
Author(s):  
Taichi Tajima ◽  
Shinya Tsuzuki ◽  
Yusuke Asai ◽  
Mio Endo ◽  
Nobuaki Matsunaga ◽  
...  
Keyword(s):  
Blood Culture ◽  
Bloodstream Infection ◽  
Hospital Setting ◽  
Bloodstream Infections ◽  
Median Number ◽  
Antimicrobial Treatment ◽  
Blood Cultures ◽  
Significant Difference ◽  
Acute Hospitals ◽  
Median Incidence

Abstract Background Blood culture tests are useful for accurate diagnosis of bacteremia and selection of antimicrobial treatment, and they are essential for instituting antimicrobial resistance (AMR) countermeasures. This study investigated blood culture submission rates in Japan and their association with the incidence of bloodstream infections. Methods Blood culture data recorded in the Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE) database from January to December 2019 and data submitted for consecutive 12 months from acute care hospitals (hospitals with a mean length of patient stay of ≤19 days) were included for analysis. Samples comprised 1 set of blood culture samples (aerobic and anaerobic bottles) defined as one submission. The annual blood culture submission rate was calculated as the total number of submitted blood cultures per 1000 patients/day. The incidence of bloodstream infections was calculated as the number of positive blood cultures excluding contaminated specimens per 1000 patients/day. The blood culture submission rate was then divided into four categories, respectively: category 1: 0–15; category 2: 15–30; category 3: 30–45; and category 4: 45–80. The Kruskal-Wallis test was performed to determine overall difference among 4 submission rate categories and the Dunn test with Bonferroni correction was used to compare pairs of submission rate categories. Filtering of facilities for data analysis Results A total of 117 hospitals were included in the analysis. The median number of beds was 415.0 (interquartile ratio [IQR]: 274.5–549.5). The median incidence of bloodstream infection was 2.78 (2.17–3.87). The median blood culture submission rate was 26.18 (17.20–35.76). The median incidence of bloodstream infection by category of blood culture submission rate was 1.39, 2.53, 3.61, and 4.48, respectively; with a significant difference observed among the four categories overall (p< 0.01). Significant differences were observed between categories 1 and 2 and between categories 2 and 3 (both p< 0.01) but not between categories 3 and 4 (p=0.758). Characteristics of the acute hospitals by category of blood culture submission rate Incidence of bloodstream infections by category of blood culture submission rate Conclusion The blood culture submission rate is considered to be around 45 in the acute hospital setting in Japan. The incidence of bloodstream infections is greatly affected by submission rates. Disclosures All Authors: No reported disclosures

scholarly journals Virulence Genotype and Clinical Influence of the Type VI Secretion System in Klebsiella Pneumoniae Isolates Causing Bloodstream Infections

2021 ◽  
Author(s):  
Yin Zhang ◽  
Ying Huang
Keyword(s):  
Klebsiella Pneumoniae ◽  
Bloodstream Infection ◽  
Virulence Genes ◽  
Bloodstream Infections ◽  
Secretion System ◽  
The Other ◽  
High Rate ◽  
Type Vi Secretion System ◽  
Type Vi Secretion ◽  
Other Hand

Abstract BackgroundKlebsiella pneumoniae (K. pneumoniae) causes bloodstream infection (BSI), which is responsible for a high rate of morbidity and mortality among different populations. In mainland China, data on the incidence and features of the T6SS gene cluster in K. pneumoniae is currently scarce. As a result, we conducted a prospective investigation to determine the involvement of the type VI secretion system (T6SS) in K. pneumoniae pathogenicity and antibiotic resistance.MethodIn this retrospective analysis, we enrolled 119 individuals who had been diagnosed with K. pneumoniae bloodstream infection and acquired demographic and clinical data from their medical records. The virulence genes rmpA, rmpA2, aerobactin, iroB, hcp, vgrG, and icmF were tested for K1 and K2, antimicrobial susceptibility. T6SS positive strains (N=20) were identified as having icmF, vgrG, and hcp, while T6SS negative strains (N=99) did not manifest the same. In this study, hvKP was defined as rmpA and aerobactin positivity. Five T6SS+ and five T6SS- isolates were chosen for the competition, serum resistance, and biofilm formation experiments to further gain insights regarding the microbiological properties of T6SS+ K. pneumoniae isolates.ResultAmong 119 isolates obtained from patients with BSIs, 20 (16.8%) were T6SS positive K. pneumoniae. T6SS positive strains had four virulence genes and a greater K1 capsular serotypes rate than T6SS negative bacteria. Among hvKP isolates, the T6SS positive rate was substantially greater than the T6SS negative rate (P = 0.001). T6SS-positive K. pneumoniae strains had a lower rate of antimicrobial resistance in comparison to T6SS-negative bacteria. The 30-day mortality in all patients was 23.1%, and 66.7% (26 patients) of them died in the first 7 days of bacteremia onset. The T6SS genotype determined no significant differences in early (7-day) mortality. On the other hand, late mortality among patients with T6SS+ isolates were 10% compared with 37.4% among patients infected by T6SS− strains (P = 0.01). In comparison to T6SS-negative isolates, K. pneumoniae isolates with T6SS-positive might outcompete Escherichia coli. T6SS+ isolates, on the other hand, did not show stronger biofilm-forming activity or a greater survival rate in presence of normal human serum in comparison to T6SS– isolates.ConclusionIndividuals with BSIs were more likely to have T6SS-positive K. pneumoniae. T6SS+ K. pneumoniae strains appeared to be extremely virulent. In T6SS‐containing K. pneumoniae, the system may play a major role in bacterial competition.

scholarly journals Clinical and Bacterial Characteristics of Klebsiella pneumoniae Affecting 30-Day Mortality in Patients With Bloodstream Infection

2021 ◽  
Vol 11 ◽  
Author(s):  
Xingbing Wu ◽  
Qingyi Shi ◽  
Shimo Shen ◽  
Chen Huang ◽  
Hongcheng Wu
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Klebsiella Pneumoniae ◽  
Bloodstream Infection ◽  
High Mortality ◽  
Virulence Genes ◽  
Genomic Analysis ◽  
Apache Ii Score ◽  
Comparative Genomic ◽  
Carbapenem Resistant

BackgroundThere is a paucity of studies using clinical characteristics and whole-genome sequencing together to fully identify the risk factors of patients with Klebsiella pneumoniae (KP) bloodstream infection (BSI).MethodsWe retrospectively analyzed the clinical and microbiological characteristics of patients with KP BSI. Isolates were processed using Illumina NGS, and relevant bioinformatics analysis was conducted (multi-locus sequence typing, serotype, phylogenetic reconstruction, detection of antibiotic resistance, and virulence genes). A logistic regression model was used to evaluate the risk factors of hosts and causative KP isolates associated with 30-day mortality in patients infected with KP BSI.ResultsOf the 79 eligible patients, the 30-day mortality rate of patients with KP BSI was 30.4%. Multivariate analysis showed that host-associated factors (increased APACHE II score and septic shock) were strongly associated with increased 30-day mortality. For the pathogenic factors, carriage of iutA (OR, 1.46; 95% CI, 1.11–1.81, p = 0.002) or Kvar_1549 (OR, 1.31; 95% CI, 1.02–1.69, p = 0.043) was an independent risk factor, especially when accompanied by a multidrug-resistant phenotype. In addition, ST11-K64 hypervirulent carbapenem-resistant KP co-harbored acquired blaKPC-2 together with iutA (76.5%, 13/17) and Kvar_1549 (100%, 17/17) genes. Comparative genomic analysis showed that they were clustered together based on a phylogenetic tree, and more virulence genes were observed in the group of ST11-K64 strains compared with ST11-non-K64. The patients infected with ST11-K64 strains were associated with relatively high mortality (47.2%, 7/17).ConclusionThe carriage of iutA and Kvar_1549 was seen to be an independent mortality risk factor in patients with KP BSI. The identification of hypervirulent and carbapenem-resistant KP strains associated with high mortality should prompt surveillance.

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