High Prevalence of Klebsiella pneumoniae Infections in AnHui Province: Clinical Characteristic and Antimicrobial Resistance

Abstract Background:High prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) has become a serious clinical concern in China. This study first described the risk factors, outcomes and antimicrobial resistance pattern of healthcare-associated KP infections in Chinese pediatric patients.Methods:This retrospective study was conducted in the nine tertiary hospitals during 2016-2018. The 324 pediatric inpatients who had KP isolated from blood and cerebrospinal fluid and had complete medical records reviewed were included. We analyzed the risk factors, outcomes and antimicrobial resistance pattern of KP-infected patients based on comparison between healthcare-associated KP infections (HAI) and community-acquired infections.Result:Of the 324 enrolled patients, 275 (84.9%) were clinically defined as HAI, including 175 (63.6%) neonates and 100 (36.4%) aged >28 days. The overall prevalence of CRKP was 35.8% (40.4% in HAI verse 10.2% in CAI, P <0.05). Prematurity (odds ratio (OR):37.07, 95% CI:8.29-165.84), hematologic malignancies (OR:15.52, 95% CI:1.89-127.14) and invasive mechanical ventilation (OR:13.09, 95% CI: 1.66-103.56) were independent risk factors for HAI. Patients from rural area (OR: 1.78, 95% CI:1.06-2.99), invasive mechanical ventilation (OR:1.79, 95% CI: 1.01-3.19), antibiotic therapy prior to admission (OR: 1.88, 95% CI:1.07-3.29) and prior hospital stay in the past 30 days (OR: 2.17, 95% CI:1.26-3.73) were associated with healthcare-associated CRKP infections. Organ dysfunction was independently correlated with poor outcomes (OR:2.92, 95% CI: 1.23-6.95)Conclusions:Pediatric invasive KP infections and high prevalence of CRKP infections largely occurred in health-care settings in China. The adequate and intensified infection control measures should be focused on high-risk hematologic patients, neonatal patients and intubated patients.

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GENES CONFERRING ANTIMICROBIAL-RESISTANCE AMONG KLEBSIELLA PNEUMONIAE IN THE ARABIAN GULF COUNTRIES: A SYSTEMATIC REVIEW AND META-ANALYSIS

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2021.v14i4.40841 ◽

2021 ◽

pp. 90-99

Author(s):

KHALID MUBARAK BINDAYNA ◽

RONNI MOL JOJI ◽

HICHAM EZZAT ◽

HAITHAM ALI JAHRAMI

Keyword(s):

Systematic Review ◽

Antimicrobial Resistance ◽

Klebsiella Pneumoniae ◽

Meta Analysis ◽

Arabian Gulf ◽

Resistance Pattern ◽

Gulf Region ◽

Gulf Countries ◽

Online Databases ◽

High Prevalence

Objective: The objective of the study was to look on the prevalence of six AMR genes (CTX-M, TEM, SHV, NDM-1, OXA-48, and VIM genes) in the province of the Arabian Gulf. We performed a systematic review and meta-analysis of the published studies from the Arabian Gulf countries and analyzed the antimicrobial resistance (AMR) genes pattern present in Klebsiella pneumoniae. Methods: The present study used the Meta-analysis Of Observational Studies in Epidemiology as a guideline for reporting findings. An electronic search was conducted in online databases such as PubMed/MEDLINE, EMBASE, Scopus, Google Scholar, Science Direct, and Web of Science from January 2014 to June 2020 following the inclusion and exclusion criteria. Articles published were included in the study resistance pattern among 2036 isolates were analyzed. These isolates conferred the AMR genes including OXA-48 (n=500), CTX-M (n= 1796), SHV (n=1637), TEM (n=1492), NDM-1 (n=500), and VIM (n=302). Results: Of 160 initially searched studies, 28 entries met the inclusion criteria and were subjected to meta-analysis. Critical appraisal of studies or quality assessment revealed a mean quality score was 4.2, with an SD of 1.6. The analysis revealed predominant AMR genes wereOXA-48 followed by CTX-M, SHV, TEM, NDM-1, and VIM in the Arabian Gulf region. Conclusion: The Arabian Gulf countries share a high prevalence of OXA-48, CTX-M followed by SHV, TEM, NDM-1, and VIM genes. Antimicrobial-resistant in K. pneumoniae is a threat to public health and this needs strong surveillance to curb this threat.

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Antimicrobial resistance trends in Escherichia coli and Klebsiella pneumoniae urinary isolates from Switzerland over a 5-year period (2009-2014)

10.26226/morressier.56d6be74d462b80296c974ba ◽

2016 ◽

Author(s):

Veronica Zanichelli

Keyword(s):

Escherichia Coli ◽

Antimicrobial Resistance ◽

Klebsiella Pneumoniae ◽

Urinary Isolates

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Inhibition of Bacterial Biofilm Formation by Phytotherapeutics with Focus on Overcoming Antimicrobial Resistance

Current Pharmaceutical Design ◽

10.2174/1381612826666200212121710 ◽

2020 ◽

Vol 26 (24) ◽

pp. 2807-2816 ◽

Cited By ~ 1

Author(s):

Yun Su Jang ◽

Tímea Mosolygó

Keyword(s):

Antimicrobial Resistance ◽

Biofilm Formation ◽

Antimicrobial Agents ◽

Bacterial Biofilm ◽

Experimental Investigations ◽

Resistant Bacteria ◽

Salmonella Spp ◽

Food Borne ◽

High Prevalence ◽

Scientific Attention

: Bacteria within biofilms are more resistant to antibiotics and chemical agents than planktonic bacteria in suspension. Treatment of biofilm-associated infections inevitably involves high dosages and prolonged courses of antimicrobial agents; therefore, there is a potential risk of the development of antimicrobial resistance (AMR). Due to the high prevalence of AMR and its association with biofilm formation, investigation of more effective anti-biofilm agents is required. : From ancient times, herbs and spices have been used to preserve foods, and their antimicrobial, anti-biofilm and anti-quorum sensing properties are well known. Moreover, phytochemicals exert their anti-biofilm properties at sub-inhibitory concentrations without providing the opportunity for the emergence of resistant bacteria or harming the host microbiota. : With increasing scientific attention to natural phytotherapeutic agents, numerous experimental investigations have been conducted in recent years. The present paper aims to review the articles published in the last decade in order to summarize a) our current understanding of AMR in correlation with biofilm formation and b) the evidence of phytotherapeutic agents against bacterial biofilms and their mechanisms of action. The main focus has been put on herbal anti-biofilm compounds tested to date in association with Staphylococcus aureus, Pseudomonas aeruginosa and food-borne pathogens (Salmonella spp., Campylobacter spp., Listeria monocytogenes and Escherichia coli).

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Molecular Epidemiology and Characterization of Carbapenem-Resistant Klebsiella pneumoniae Isolated from Urine at a Teaching Hospital in Taiwan

Microorganisms ◽

10.3390/microorganisms9020271 ◽

2021 ◽

Vol 9 (2) ◽

pp. 271

Author(s):

Yuarn-Jang Lee ◽

Chih-Hung Huang ◽

Noor Andryan Ilsan ◽

I-Hui Lee ◽

Tzu-Wen Huang

Keyword(s):

Klebsiella Pneumoniae ◽

Teaching Hospital ◽

Efflux Pump ◽

Resistance Mechanisms ◽

Pcr Analysis ◽

Carbapenem Resistant ◽

High Prevalence ◽

Antimicrobial Susceptibility Tests ◽

Susceptibility Tests ◽

Tract Infections

Urinary tract infections (UTIs) are common in clinics and hospitals and are associated with a high economic burden. Enterobacterium Klebsiella pneumoniae is a prevalent agent causing UTIs. A high prevalence of carbapenem-resistant K. pneumoniae (CRKP) has emerged recently and is continuing to increase. Seventeen urinary CRKP isolates collected at a teaching hospital in Taiwan from December 2016 to September 2017 were analyzed to elucidate their drug resistance mechanisms. Two-thirds of the isolates were obtained from outpatients. Antimicrobial susceptibility tests demonstrated multidrug resistance in all the isolates. Multilocus sequence typing analysis showed high diversity among the isolates. PCR analysis demonstrated the presence of carbapenemases in three isolates. All isolates carried at least one other extended-spectrum β-lactamase, including TEM, DHA, and CTX-M. Fifteen isolates contained mutations in one of the outer membrane porins that were assessed. The expression levels of the acrB and/or oqxB efflux pump genes, as determined by qRT-PCR, were upregulated in 11 isolates. Six isolates might have utilized other efflux pumps or antimicrobial resistance mechanisms. These analyses demonstrated a highly diverse population and the presence of complex resistance mechanisms in urinary isolates of K. pneumoniae.

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Clinical and microbiological characteristics of nosocomial, healthcare-associated, and community-acquired Klebsiella pneumoniae infections in Guangzhou, China

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-021-00910-1 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Tingting Le ◽

Ling Wang ◽

Chaoying Zeng ◽

Leiwen Fu ◽

Zhihua Liu ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Klebsiella Pneumoniae ◽

Bacterial Resistance ◽

Empirical Therapy ◽

Clonal Diversity ◽

Extended Spectrum Beta Lactamase ◽

Microbiological Characteristics ◽

Carbapenemase Gene ◽

Cross Transmission ◽

Healthcare Associated

Abstract Background Klebsiella pneumoniae (K. pneumoniae) is a common pathogen associated with hospital and community-onset infections. This study aimed to compare the clinical and microbiological characteristics of nosocomial, healthcare-associated (HCA), and community-acquired (CA) K. pneumoniae infections. Methods Clinical data were extracted from electronic medical records and analyzed retrospectively. Antimicrobial susceptibility and extended-spectrum beta-lactamase (ESBL) production were determined for all identified strains. Carbapenemase and ESBL genes were amplified by PCR. Genotyping of carbapenem-resistant K. pneumoniae (CRKP) and ESBL-producing strains was performed by pulsed-field gel electrophoresis (PFGE). Results Of 379 K. pneumoniae infections, 98 (25.9%) were nosocomial, 195 (51.5%) were healthcare-associated, and 86 (22.6%) were community-acquired. Hematological malignancy (OR = 4.467), and hypertension (OR = 2.08) and cerebral vascular disease (OR = 2.486) were associated with nosocomial and HCA infections respectively, when compared to CA infections. Overall, the incidence of antimicrobial resistance for the majority of agents tested was similar between nosocomial and HCA infections (P > 0.05) and both groups had a higher incidence than CA infections (P < 0.05). Moreover, 95.1% (78/82) of CRKP strains were isolated from the nosocomial and HCA groups. The blaKPC was the most prevalent carbapenemase gene among CRKP strains (80.5%, 66/82). ESBL-producing strains were prevalent among nosocomial (40.8%), HCA (35.9%) and CA groups (24.4%). The blaCTX-M-9-group and blaCTX-M-1-group genes were predominant in nosocomial (65.0%) and CA strains (66.7%), respectively. PFGE results showed ESBL-producing and CRKP strains were genetically diverse. Identical PFGE profiles were observed among HCA and nosocomial strains. Conclusions Nosocomial and HCA K. pneumoniae infections presented similar clinical features and antimicrobial resistance, and both two types of infections were different to CA infections. CRKP and ESBL-producing strains were disseminated mainly in HCA and nosocomial groups, and showed a clonal diversity. The cross transmission of CRKP was existed among HCA and nosocomial patients. This finding suggests that similar empirical therapy should be considered for patients with nosocomial and HCA K. pneumoniae infections and bacterial resistance surveillance of these infections is necessary.

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Geographical information system and spatial–temporal statistics for monitoring infectious agents in hospital: a model using Klebsiella pneumoniae complex

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-021-00944-5 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Priscila Pinho da Silva ◽

Fabiola A. da Silva ◽

Caio Augusto Santos Rodrigues ◽

Leonardo Passos Souza ◽

Elisangela Martins de Lima ◽

...

Keyword(s):

Information System ◽

Antimicrobial Resistance ◽

Klebsiella Pneumoniae ◽

Tertiary Hospital ◽

Physical Structure ◽

Space Time ◽

Geographical Information ◽

Infectious Agents ◽

Healthcare Associated Infection ◽

Temporal Statistics

Abstract Background The emergence and spread of antimicrobial resistance and infectious agents have challenged hospitals in recent decades. Our aim was to investigate the circulation of target infectious agents using Geographic Information System (GIS) and spatial–temporal statistics to improve surveillance and control of healthcare-associated infection and of antimicrobial resistance (AMR), using Klebsiella pneumoniae complex as a model. Methods A retrospective study carried out in a 450-bed federal, tertiary hospital, located in Rio de Janeiro. All isolates of K. pneumoniae complex from clinical and surveillance cultures of hospitalized patients between 2014 and 2016, identified by the use of Vitek-2 system (BioMérieux), were extracted from the hospital's microbiology laboratory database. A basic scaled map of the hospital’s physical structure was created in AutoCAD and converted to QGis software (version 2.18). Thereafter, bacteria according to resistance profiles and patients with carbapenem-resistant K. pneumoniae (CRKp) complex were georeferenced by intensive and nonintensive care wards. Space–time permutation probability scan tests were used for cluster signals detection. Results Of the total 759 studied isolates, a significant increase in the resistance profile of K. pneumoniae complex was detected during the studied years. We also identified two space–time clusters affecting adult and paediatric patients harbouring CRKp complex on different floors, unnoticed by regular antimicrobial resistance surveillance. Conclusions In-hospital GIS with space–time statistical analysis can be applied in hospitals. This spatial methodology has the potential to expand and facilitate early detection of hospital outbreaks and may become a new tool in combating AMR or hospital-acquired infection.

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A case of neck abscess caused by rare hypervirulent Klebsiella pneumoniae, capsular type K20 and sequence type 420

Annals of Clinical Microbiology and Antimicrobials ◽

10.1186/s12941-021-00453-8 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

John Alexander McHardy ◽

Vathshalan Selvaganeshapillai ◽

Priya Khanna ◽

Ashley Michael Whittington ◽

Jane Turton ◽

...

Keyword(s):

Public Health ◽

Case Report ◽

Antimicrobial Resistance ◽

Klebsiella Pneumoniae ◽

East Asia ◽

South East Asia ◽

Neck Abscess ◽

Global Challenge ◽

Life Threatening ◽

The Uk

Abstract Background This case report describes a neck abscess caused by a strain of Hypervirulent Klebsiella pneumoniae in a middle aged man with diabetes without a history of travel to East and South East Asia. This case report is of notable significance as Hypervirulent Klebsiella pneumoniae neck abscesses are rarely seen in the UK and are very infrequently documented in individuals who have not first travelled to the high prevalence areas of East and South East Asia. Case presentation This case report describes a 53 year old diabetic man who contracted a Hypervirulent Klebsiella pneumoniae neck abscess which led to the development of sepsis. Klebsiella pneumoniae was cultured from blood cultures and fluid aspirated from the abscess grew the pathogen with same antimicrobial susceptibility. Hypervirulence was demonstrated after the samples were analysed, at the Antimicrobial Resistance and Healthcare Associated Infections Reference Unit Public Health England Colindale, and found to contain the K20 (rmp)A and rmpA2 virulence genes. Discussion Hypervirulent Klebsiella pneumoniae is a Gram-negative, encapsulated, non-motile bacillus notable for its ability to metastatically spread and cause potentially life threatening infections in otherwise healthy adults, but especially in those with diabetes. Genes responsible for the production of hyperviscous mucoid polysaccharide capsules and siderophores, such as those isolated in this case, enable the bacteria to more efficiently evade the hosts immune system and disseminate and invade surrounding and distant tissues. Data from Public Health England shows Hypervirulent Klebsiella pneumoniae are rare in the UK. A review of current literature also showed Hypervirulent Klebsiella pneumoniae almost exclusively occur in those who have traveled to East and South East Asia. Conclusions This case reported a rare Hypervirulent Klebsiella pneumoniae neck abscess outside of, and without travel to, East and South East Asia. This raises concerns about future, potentially life threatening, Hypervirulent Klebsiella pneumoniae infections becoming more widespread without the need for endemic travel. This concern is further exacerbated by the growing global challenge of antimicrobial resistance.

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Diversity and Prevailing Antimicrobial Resistance in Blood Stream Pathogens at NICU of a Tertiary Care Institute in Kolkata

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/167 ◽

2021 ◽

Vol 8 (14) ◽

pp. 854-860

Author(s):

Nandita Pal ◽

Sanat Kumar Dolui ◽

Bhuban Majhi ◽

Manisha Das

Keyword(s):

Antimicrobial Resistance ◽

Blood Culture ◽

Klebsiella Pneumoniae ◽

Late Onset ◽

Tertiary Care ◽

Burkholderia Cepacia Complex ◽

Multi Drug Resistance ◽

Coagulase Negative Staphylococcus ◽

Neonatal Septicaemia ◽

Early Onset Sepsis

BACKGROUND Septicaemia is a leading cause of morbidity and mortality in neonates. Antimicrobial prescription for neonatal septicaemia (NS) should be wisely used depending on the regional spectra of infecting microbes and their antimicrobial resistance (AMR) patterns which vary over time, place and host factors. METHODS This was a descriptive cross-sectional study conducted from January 2017 to June 2017 among 102 cases of NS admitted in neonatal intensive care units (NICU). Demographic data of the concerned neonates was collected through a predesigned checklist. Blood collected from neonates was processed for culture and sepsis screen. Antimicrobial susceptibility testing was performed for the cultured isolates and phenotypic AMR patterns were observed. RESULTS Most of the studied neonates had subnormal birth weight (86). Blood culture showed predominance of gram-negative bacilli (GNB) among which Klebsiella pneumoniae was the most common followed by Burkholderia cepacia complex. Coagulase negative staphylococcus species (CoNS) was most numerous among the cultured gram-positive cocci (GPC). Candidemia of late onset was confirmed in 25 neonates. Early onset sepsis was predominantly caused by GNB (29 / 31) predominated by Klebsiella pneumoniae. Multi drug resistant (MDR) pathogens viz., extended spectrum beta-lactamase (ESBL) producing GNB, carbapenem resistant-GNB (CR-GNB) and methicillin resistant staphylococcus (MRS) phenotypes were notably prevalent. CONCLUSIONS Multidrug resistant microorganisms are notably prevalent in neonatal septicaemia. In clinically suspected very sick septicaemic neonates not showing much improvement with guideline-led empirical antimicrobial therapy, an early antibiogram guided change over to meropenem and amikacin or even to colistin in case of reported carbapenem resistance, is highly recommended. KEYWORDS Antimicrobial Resistance, Blood Culture, Multi Drug Resistance, Neonatal Septicaemia

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Healthcare associated pneumonia: An old concept at a hospital with high prevalence of antimicrobial resistance

MedPharmRes ◽

10.32895/ump.mpr.5.2.4 ◽

2021 ◽

Vol 5 (2) ◽

pp. 17-21

Author(s):

Lam Nguyen-Ho ◽

Duong Hoang-Thai ◽

Vu Le-Thuong ◽

Ngoc Tran-Van

Keyword(s):

Risk Factor ◽

Antimicrobial Resistance ◽

Multidrug Resistant ◽

Community Acquired Pneumonia ◽

Resistant Organism ◽

Healthcare Associated Infection ◽

Female Ratio ◽

High Prevalence ◽

Need To Evaluate ◽

Healthcare Associated

Background: One of several reasons that the concept of healthcare-associated pneumonia (HCAP) was dismissed was the same presence of multidrug resistant organism (MDRO) between community-acquired pneumonia and HCAP at countries with the low prevalence of antimicrobial resistance (AMR). However, this finding could be unsuitable for countries with the high rates of AMR. Methods: A prospective observational study was conducted at the respiratory department of Cho Ray hospital from September 2015 to April 2016. All adult patients suitable for community acquired pneumonia (CAP) with risk factor for healthcare-associated infection were included. Results: We found out 130 subjects. The median age was 71 years (interquartile range 57-81). The male/female ratio was 1.55:1. Prior hospitalization was the most common risk factor for healthcare-associated infection. There were 35 cases (26.9%) with culture-positive (sputum and/or bronchial lavage). Isolated bacteria included Pseudomonas aeruginosa (9 cases), Klebsiella pneumoniae (9 cases), Escherichia coli (4 cases), Acinetobacter baumannii (6 cases), and Staphylococcus aureus (7 cases) with the characteristic of AMR similar to the bacterial spectrum associated with hospital-acquired pneumonia. Conclusion: MDROs were detected frequently in CAP patients with risk factor for healthcare-associated infection at the hospital with the high prevalence of AMR. This requires the urgent need to evaluate risk factors for MDRO infection in community-onset pneumonia when the concept of HCAP is no longer used.

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