scholarly journals High rates of metallo-beta-lactamase-producing Klebsiella pneumoniae in Greece - a review of the current evidence

2008 ◽  
Vol 13 (4) ◽  
pp. 7-8 ◽  
Author(s):  
A Vatopoulos
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Surveillance System ◽  
Inhibitory Concentration ◽  
Clinical Laboratory ◽  
Current Evidence ◽  
Beta Lactamase ◽  
Carbapenem Resistant ◽  
Hospital Wards

For the last four years Greece has faced a large number of infections, mainly in the intensive care units (ICU), due to carbapenem-resistant, VIM-1-producing Klebsiella pneumoniae. The proportion of imipenem-resistant K. pneumoniae has increased from less than 1% in 2001, to 20% in isolates from hospital wards and to 50% in isolates from ICUs in 2006. Likewise, in 2002, these strains were identified in only three hospitals, whereas now they are isolated in at least 25 of the 40 hospitals participating in the Greek Surveillance System. This situation seems to be due to the spread of the blaVIM-1 cassette among the rapidly evolving multiresistant plasmids and multiresistant or even panresistant strains of mainly K. pneumoniae and also other enterobacterial species. However, the exact biological basis of this phenomenon and the risk factors that facilitate it are not yet fully understood. Moreover, the fact that most strains display minimum inhibitory concentration (MIC) values below or near the Clinical Laboratory Standard Institute (CLSI) resistance breakpoint create diagnostic and therapeutic problems, and possibly obstruct the assessment of the real incidence of these strains.

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.

Characteristics, risk factors and outcomes of carbapenem-resistant Klebsiella pneumoniae infections in the intensive care unit

2015 ◽  
Vol 70 (6) ◽  
pp. 592-599 ◽  
Author(s):  
Konstantinos Z. Vardakas ◽  
Dimitrios K. Matthaiou ◽  
Matthew E. Falagas ◽  
Elli Antypa ◽  
Asimoula Koteli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Carbapenem Resistant

scholarly journals Risk Factors for Carbapenem Resistant Klebsiella pneumoniae Hospital Infection in the Intensive Care Unit

2018 ◽  
Vol 19 (3) ◽  
pp. 255-261
Author(s):  
Zorana M. Djordjevic ◽  
Marko M. Folic ◽  
Nevena Gajovic ◽  
Slobodan M. Jankovic
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Surgical Intensive Care Unit ◽  
Multivariate Logistic Regression ◽  
Surgical Intensive Care ◽  
Carbapenem Resistant

Abstract Carbapenem-resistant Klebsiella pneumoniae (CR-Kp) has become a major threat to patients in hospitals, increasing mortality, length of stay and costs. The aim of this study was to discover risk factors for the development of hospital infections (HIs) caused by CR-Kp. A prospective cohort study was conducted in the Medical-Surgical Intensive Care Unit of the Clinical Centre in Kragujevac, Kragujevac, Serbia, from January 1, 2011, to December 31, 2015. The “cases” were patients with HIs caused by CR-Kp, while the “controls” were patients infected with carbapenem-sensitive Klebsiella pneumoniae (CS-Kp). The significance of multiple putative risk factors for HIs caused by CR-Kp was tested using multivariate logistic regression. Although univariate analyses pointed to many risk factors, with a significant influence on the occurrence of hospital CR-Kp infections, the multivariate logistic regression identified five independent risk factors: use of mechanical ventilation (OR=6.090; 95% CI=1.030-36.020; p=0.046); length of antibiotic therapy before HIs (days) (OR=1.080; 95% CI=1.003-1.387; p=0.045); previous use of carbapenems (OR=7.005; 95% CI=1.054-46.572; p=0.044); previous use of ciprofloxacin (OR=20.628; 95% CI=2.292-185.687; p=0.007) and previous use of metronidazole (OR=40.320; 95% CI=2.347-692.795; p=0.011) HIs caused by CR-Kp are strongly associated with the use of mechanical ventilation and the duration of the previous use of certain antibiotics (carbapenems, ciprofloxacin and metronidazole).

The Colonization of Carbapenem-Resistant Klebsiella pneumoniae: Epidemiology, Resistance Mechanisms, and Risk Factors in Patients Admitted to Intensive Care Units in China

2020 ◽  
Vol 221 (Supplement_2) ◽  
pp. S206-S214 ◽  
Author(s):  
Xiaohua Qin ◽  
Shi Wu ◽  
Min Hao ◽  
Jing Zhu ◽  
Baixing Ding ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Consensus Sequence ◽  
Resistance Mechanisms ◽  
Transmitted Infection ◽  
Icu Patients ◽  
Icu Stay ◽  
Carbapenem Resistant ◽  
Increased Risk

Abstract Background Carbapenem-resistant Klebsiella pneumoniae (CRKP) has become a threat to public health, most notably as a superbug causing nosocomial infections. Patients in the intensive care unit (ICU) are at increased risk of hospital-acquired K pneumoniae infection, especially CRKP. This study was conducted to investigate the frequency of gastrointestinal and nasopharyngeal K pneumoniae colonization and its contribution to infections in ICU patients. Methods A 3-month prospective cohort study was performed in which 243 ICU patients were screened for intestinal and nasopharyngeal carriage of K pneumoniae at admission and once per week thereafter. The colonization and clinical infection isolates were analyzed by antimicrobial susceptibility testing to identify CRKP and were characterized by multilocus sequence typing (MLST) and whole-genome sequencing combined with epidemiological data to investigate the resistance mechanisms and assess the possible transmitted infection. Results Twenty-eight percent (68 of 243) of patients tested positive for carriage of K pneumoniae immediately upon admission to ICU, 54% (37 of 68) of which were nonduplicate CRKP isolates. Patients with carbapenem-susceptible K pneumoniae (CSKP) colonization at admission were more likely to acquire CRKP colonization during the ICU stay compared with patients without K pneumoniae colonization at admission. The incidence of subsequent CRKP infection in the baseline CSKP (32.3%, 10 of 31) and CRKP (45.9%, 17 of 37) carrier group was significantly higher than that of the baseline non-KP carrier group (8.6%, 15 of 175). The risk factors associated with acquired CRKP colonization during the ICU stay among negative CRKP colonization at admission included previous exposure to carbapenem, tigecycline or β-lactam/β-lactamases inhibitor, and invasive processes or surgical operations. Sixty-four percent (27 of 42) of patients with K pneumoniae infection were colonized by clonally related K pneumoniae strains according to enterobacterial repetitive intergenic consensus sequence-polymerase chain reaction analysis. ST11 (72%, 53 of 74) was the most predominant MLST type of clonally related CRKP isolate colonizing these patients, followed by ST15 (26%, 19 of 74). Conclusions The colonization of K pneumoniae may increase the incidence of corresponding K pneumoniae infection in critically ill patients in the ICU. High prevalence of ST11 CRKP (due to blaKPC-2) carriage and infection in ICU was observed.

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