scholarly journals Emergence of KPC-2-Producing ST11-K64 Hypervirulent Klebsiella Pneumoniae for the Elderly in Intensive Care Unit: Antimicrobial Resistance, Molecular and Clinical Characteristics

2021 ◽  
Author(s):  
Tian Wei ◽  
Cheng-yun Zou ◽  
Jie Qin ◽  
Jian-min Tao ◽  
Li Yan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Elderly Patients ◽  
Antimicrobial Agents ◽  
Statistical Significance ◽  
Virulence Gene ◽  
Molecular Characteristics ◽  
Global Public Health ◽  
Carbapenem Resistant

Abstract Background: In recent years, carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) has been increasingly reported and poses severe therapeutic challenge to global public health, but has not yet been systematically studied in elderly patients. This study aimed to investigate the clinical and molecular characteristics and risk factors of CR-hvKP infections in elderly patients. Methods: We retrospectively investigated elderly patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) infections in intensive care unit (ICU),between January 2020 and December 2020, the clinical data being collected from medical records, and microbiological data including antimicrobial susceptibility testing, phenotype experiment, carbapenemases production, string test, virulence gene, capsular serotype-specific (cps) genes and multilocus sequence typing, of the CR-hvKP group defined by the presence of some combination of rmpA, rmpA2, iucA, iroB, and peg-344 was compared with those of carbapenem-resistant non-hypervirulent Klebsiella pneumoniae (CR-non-hvKP) strains.Results: Of 80 CRKP strains, 51(63.8%) met the definition of CR-hvKP and 7 of them had all five of the virulence genes tested. The main mechanism of resistance to carbapenems found in CR-hvKP strains was the presence of the blaKPC-2 gene. There was no statistical significance in the resistance rates of antimicrobial agents between the CR-hvKP and CR-non-hvKP subgroups (p ≥ 0.05). Compared with the minimum inhibitory concentration (MIC) 50 values of CR-non-hvKP group, those of antimicrobials, including ceftazidime, ceftazidime/avibactam, imipenem/avibactam, tigecycline, levofloxacin, cefoperazone-sulbactam, exhibited higher levels in the CR-hvKP group. Avibactam (4 µg/mL) significantly decreased the MIC90 values more than sixteen-fold than that of ceftazidime and imipenem alone against KPC-2-producing Klebsiella pneumoniae. K64 and ST11 were highly prevalent and strongly associated with CR-hvKP (P<0.05). Cardiovascular disease (odds ratio [OR] = 11.956) and ST11-K64 (OR= 8.385) appeared to be independent variables associated with CR-hvKP infection by multivariate analysis.Conclusion: The CR-hvKP strains showed higher MIC50 values than CR-non-hvKP strains. KPC-2-producing ST11-K64 CR-hvKP is emerging, which might become new significant “superbugs” and a threat to elderly patients.

scholarly journals An Outbreak of Carbapenem-Resistant Klebsiella pneumoniae in an Intensive Care Unit of a Major Teaching Hospital in Chongqing, China

2021 ◽  
Vol 11 ◽  
Author(s):  
Lingyi Zeng ◽  
Chengru Yang ◽  
Jisheng Zhang ◽  
Kewang Hu ◽  
Jingbo Zou ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Large Scale ◽  
Virulence Genes ◽  
Control Strategies ◽  
Resistant Bacteria ◽  
Molecular Characteristics ◽  
Dilution Method ◽  
Carbapenem Resistant

BackgroundDue to the critical condition and poor immunity of patients, the intensive care unit (ICU) has always been the main hospital source of multidrug-resistant bacteria. In recent years, with the large-scale use of antibiotics, the detection rate and mortality of carbapenem-resistant Klebsiella pneumoniae (CRKP) have gradually increased. This study explores the molecular characteristics and prevalence of CRKP isolated from the ICU ward of a tertiary hospital in China.MethodsA total of 51 non-duplicated CRKP samples isolated from the ICU were collected from July 2018–July 2020. The enzyme production of the strains was preliminarily screened by carbapenemase phenotypic test, and drug-resistant and virulence genes were detected by PCR. The transferability of plasmid was verified by conjugation test. The minimal inhibitory concentration (MIC) was determined by microbroth dilution method and genetic diversity was detected by multilocus sequence typing and pulsed-field gel electrophoresis.ResultsblaKPC-2 was the only carbapenemase detected. The major virulence genes were uge (100%), mrkD (94.1%), kpn (94.1%), and fim-H (72.5%), while wcag, ironB, alls and magA genes were not detected. One sequence type ST1373 strain, hypervirulent K. pneumoniae (hvKP), was detected. CRKP strains were highly resistant to quinolones, cephalosporins, aminoglycosides, and polymyxin, but susceptive to tigecycline and ceftazidime–avibactam. The success rate of conjugation was 12.2%, indicating the horizontal transfer of blaKPC-2. Homology analysis showed that there was a clonal transmission of ST11 CRKP in the ICU of our hospital.ConclusionThe present study showed the outbreak and dissemination in ICU were caused by ST11 CRKP, which were KPC-2 producers, and simultaneously, also carried some virulence genes. ST11 CRKP persisted in the ward for a long time and spread among different areas. Due to the widespread dispersal of the transferable blaKPC-2 plasmid, the hospital should promptly adopt effective surveillance and strict infection control strategies to prevent the further spread of CRKP. Ceftazidime–avibactam showed high effectiveness against CRKP and could be used for the treatment of ICU infections.

scholarly journals An Outbreak of Carbapenem-Resistant Klebsiella Pneumoniae of K57 Capsular Serotype in an Emergency Intensive Care Unit of a Teaching Hospital in China

2020 ◽  
Author(s):  
Chunhong Shao ◽  
Yan Jin ◽  
Shuang Liu ◽  
Meijie Jiang ◽  
Shuping Zhao
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Teaching Hospital ◽  
Galleria Mellonella ◽  
Pulse Field ◽  
Carbapenem Resistant ◽  
Surrounding Environment ◽  
Antimicrobial Resistance Genes ◽  
Broth Microdilution Method

Abstract Background: Klebsiella pneumoniae is a common causative pathogen of nosocomial infections. The emergence of carbapenem-resistant hypervirulent K. pneumoniae (CR-hvKP) strains has further increased the threat posed by this bacterium. Here, we described an outbreak of 32 CR-hvKP isolates from the emergency intensive care unit (EICU) of a teaching hospital in China. Methods: From January 29, 2019 to March 11, 2019, 32 CRKp isolates were collected from 6 patients and their surrounding environment in EICU. Patient information including age, gender, length of EICU stay, diagnosis, treatment, and outcomes were obtained from electronic medical records. The isolates were identified using Vitek-MS system. The hypermucoviscosity phenotype was determined by the “string test”. Antimicrobial susceptibility testing was performed using VITEK 2 compact system, E-test or the broth microdilution method. All isolates were serotyped for K1, K2, K5, K20, K54, and K57 serotypes, antimicrobial resistance genes and twelve virulence-associated genes were screened using PCR and DNA sequencing. Multilocus sequence typing (MLST) and pulse-field gel electrophoresis (PFGE) were employed to characterize the genetic relationships among the CPKP isolates. The virulence capability of 11 CRKp isolates from 6 patients was evaluated through Galleria mellonella larva infection assay. Results: This outbreak involved 6 patients and lasted for 40 days. All 32 CR-hvKp isolates were obtained from 6 patients and their surrounding environment. PFGE showed that all 32 isolates belonged to one cluster, and MLST revealed that belonged to ST11. All isolates exhibited high resistance to β-lactam antibiotics, quinolones, and aminoglycosides. They were susceptible to ceftazidime/averbatan, tigecycline, and colistin. All 32 isolates harbored multiple resistance determinants, including blaKPC-2, blaSHV-11, blaTEM-1, rmtB, and qnrD. The serotype of all 32 isolates was K57 that was rarely reported. In the virulence gene analysis, all 32 isolates contained 6 virulence genes, namely, fimH, iucB, mrkD, rmpA, uge, and wabG. Infection assays demonstrated high mortality in the Galleria mellonella model. Following measures implemented by the hospital, the outbreak was controlled. The mortality rate was 83.3%.Conclusions: The epidemiology of CR-hvKP should be monitored closely to detect early indications of this emerging public health threat.

The epidemiology, risk factors and outcomes of Carbapenem-resistant Klebsiella pneumoniae infections in the intensive care unit from 2012 to 2018

2020 ◽  
Author(s):  
Ping Wang ◽  
Xiaocui Zou ◽  
Boting Zhou ◽  
Tao Yin
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Control Measures ◽  
Icu Patients ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Incidence And Mortality ◽  
Changing Trend ◽  
Different Sources

Abstract Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an increasing globally threat for human health, but the trends and clinical characteristics of CRKP infections in the intensive care unit(ICU) remain uninvestigated.Methods: A retrospective study was conducted among ICU patients infected with KP isolates from January 2012 to December 2018. Carbapenem resistant to Klebsiella pneumoniae was defined according to Clinical and Laboratory Standards Institute (CLSI) criteria. The incidence and changing trend of CRKP were determined. CRKP patient sources, specimen types, infection sources and outcomes were investigated. Results: There were 256(40.13%) patients with CRKP and 382(59.87%) patients with CSKP. The incidence of CRKP increased from 2012(11.11%) to 2017(63.48%) and decreased in 2018(51.52%). The proportion of isolates not susceptible to three carbapenems increased from 0 to 98.04%. The rates of CRKP isolated from blood, wound, urine and pleural fluid were higher than that of CSKP. CRKP infections were mainly ICU acquired, rather than input acquired. Conclusion: The incidence of CRKP was high in ICU, but showed a downward trend. Implementation of different infection control measures to different sources of patients, specimen types, and KP infections are necessary. Surveillance data will be needed for ICU patients to decrease the incidence and mortality of CRKP.

Carbapenem-Resistant Klebsiella pneumoniae Outbreak in a Neonatal Intensive Care Unit: Risk Factors for Mortality

2020 ◽  
Author(s):  
Meltem Bor ◽  
Ozkan Ilhan
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Congenital Anomalies ◽  
Neonatal Intensive Care ◽  
Carbapenem Resistant ◽  
Group 2 ◽  
Antifungal Use ◽  
Group 1

Abstract Aim The aim of our study was to determine the factors associated with mortality in neonates with carbapenem-resistant Klebsiella pneumoniae (CRKP). Material and methods This retrospective, single-center study was conducted in the Neonatal Intensive Care Unit of Harran University Faculty of Medicine between January 2017 and July 2018 who had CRKP growth in their blood, urine or cerebrospinal fluid cultures. The discharged group was designated as the control group (Group 1), whereas the group that faced mortality was classified as the case group (Group 2). The demographic data, clinical findings and laboratory and microbiological results of the two groups were compared to identify risk factors. Results A total of 58 patients (36 in Group 1 and 22 in Group 2) exhibited CRKP growth during the study period. Low birth weight (p = 0.039), previous antifungal (p = 0.002) or amikacin use (p = 0.040), congenital anomalies (p = 0.002), total parenteral nutrition (TPN) administration (p = 0.002), surgery (p = 0.035), thrombocytopenia (p = 0.007), low platelet mass index (p = 0.011), elevated C-reactive protein (p = 0.004), high carbapenem minimum inhibitory concentration (MIC) (p = 0.029) and high amikacin MIC (p = 0.019) were associated with mortality. In a multivariate regression analysis, previous antifungal use (p = 0.028), congenital anomalies (p = 0.032) and TPN use (p = 0.013) were independent factors in predicting mortality. Conclusion Previous antifungal use, congenital anomalies and TPN use were found to be independent risk factors for mortality in neonates with CRKP infection.

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