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.

scholarly journals Characterization of a blaNDM-1-Bearing IncHI5-Like Plasmid From Klebsiella pneumoniae of Infant Origin

2021 ◽  
Vol 11 ◽  
Author(s):  
Ziyi Liu ◽  
Ruifei Chen ◽  
Poshi Xu ◽  
Zhiqiang Wang ◽  
Ruichao Li
Keyword(s):  
Klebsiella Pneumoniae ◽  
Genomic Analysis ◽  
Comparative Genomic ◽  
Genetic Composition ◽  
Carbapenem Resistant ◽  
Antimicrobial Resistance Genes ◽  
Genes Encoding ◽  
History Of ◽  
Core Genes

The spread of plasmid-mediated carbapenem-resistant clinical isolates is a serious threat to global health. In this study, an emerging NDM-encoding IncHI5-like plasmid from Klebsiella pneumoniae of infant patient origin was characterized, and the plasmid was compared to the available IncHI5-like plasmids to better understand the genetic composition and evolution of this emerging plasmid. Clinical isolate C39 was identified as K. pneumoniae and belonged to the ST37 and KL15 serotype. Whole genome sequencing (WGS) and analysis revealed that it harbored two plasmids, one of which was a large IncHI5-like plasmid pC39-334kb encoding a wide variety of antimicrobial resistance genes clustered in a single multidrug resistance (MDR) region. The blaNDM-1 gene was located on a ΔISAba125-blaNDM-1-bleMBL-trpF-dsbC structure. Comparative genomic analysis showed that it shared a similar backbone with four IncHI5-like plasmids and the IncHI5 plasmid pNDM-1-EC12, and these six plasmids differed from typical IncHI5 plasmids. The replication genes of IncHI5-like plasmids shared 97.06% (repHI5B) and 97.99% (repFIB-like) nucleotide identity with those of IncHI5 plasmids. Given that pNDM-1-EC12 and all IncHI5-like plasmids are closely related genetically, the occurrence of IncHI5-like plasmid is likely associated with the mutation of the replication genes of pNDM-1-EC12-like IncHI5 plasmids. All available IncHI5-like plasmids harbored 262 core genes encoding replication and maintenance functions and carried distinct MDR regions. Furthermore, 80% of them (4/5) were found in K. pneumoniae from Chinese nosocomial settings. To conclude, this study expands our knowledge of the evolution history of IncHI5-like plasmids, and more attention should be paid to track the evolution pathway of them among clinical, animal, and environmental settings.

scholarly journals Risk Factors of 30-Day All-Cause Mortality in Patients with Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infection

2021 ◽  
Vol 11 (7) ◽  
pp. 616
Author(s):  
Keh-Sen Liu ◽  
Yao-Shen Tong ◽  
Ming-Tsung Lee ◽  
Hung-Yu Lin ◽  
Min-Chi Lu
Keyword(s):  
Risk Factors ◽  
Platelet Count ◽  
Klebsiella Pneumoniae ◽  
Bloodstream Infection ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Carbapenem Resistant ◽  
All Cause Mortality ◽  
Insight Into ◽  
Antimicrobial Regimen

An optimal antimicrobial regimen for the treatment of patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infection (BSI) is currently unavailable. This study aimed to identify the appropriate antibiotics and the risk factors of all-cause mortality for CRKP BSI patients. This retrospective cohort study included the hospitalized patients with CRKP BSI. Primary outcome was 30-day all-cause mortality. Cox regression analysis was used to evaluate the risk factors of 30-day mortality. A total of 89 patients were included with a 30-day mortality of 52.1%. A total of 52 (58.4%) patients were treated with appropriate antimicrobial regimens and 58 (65.2%) isolates carried blaKPC-2 genes. Microbiologic eradication within 7 days (adjusted hazard ratio [HR] = 0.09, p < 0.001), platelet count (per 1 × 104/mm3, adjusted HR = 0.95, p = 0.002), and Pitt bacteremia scores (adjusted HR = 1.40, p < 0.001) were independently associated with 30-day all-cause mortality. No effective antimicrobial regimens were identified. In conclusion, risk factors of 30-day mortality in patients with CRKP BSI included microbiologic eradication > 7 days, lower platelet count, and a higher Pitt bacteremia score. These findings render a new insight into the clinical landscape of CRKP BSI.

scholarly journals A retrospective study of risk factors for carbapenem-resistant Klebsiella pneumoniae acquisition among ICU patients

2016 ◽  
Vol 10 (03) ◽  
pp. 208-213 ◽  
Author(s):  
Yangmin Hu ◽  
Yanting Ping ◽  
Leiqing Li ◽  
Huimin Xu ◽  
Xiaofeng Yan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Klebsiella Pneumoniae ◽  
Independent Risk Factor ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Clinical Factor ◽  
Icu Patients ◽  
Carbapenem Resistant ◽  
Bivariable Analysis

Introduction: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is rapidly emerging as a life-threatening nosocomial infection. In this study, we aim to identify risk factors, especially antibiotic use, for CRKP infection among intensive care unit (ICU) patients. Methodology: This was a matched case-control study of a 67-bed ICU in a tertiary care teaching hospital from 1 January 2011 through 30 June 2013. The control cases were selected among the patients with carbapenem-susceptible Klebsiella pneumoniae (CSKP) and were matched with CRKP cases for year of ICU admission and site of infection. The clinical outcomes and antibiotic treatments were analyzed. Results: One hundred and thirty patients were included in the study (65 cases and 65 controls). Bivariable analysis showed that age of patients (p = 0.044), number of antibiotic groups (p = 0.001), and exposure to carbapenems (p < 0.001) were associated with CRKP infection. Using multivariate analysis adjusted for age, prior hospitalization, number of antibiotic groups, and previous exposure to carbapenems, previous carbapenem exposure (p < 0.001) was identified as an independent risk factor for CRKP infection. Conclusions: These data suggest that exposure to carbapenems is an independent risk factor for CRKP infection. Patients with this clinical factor should be targeted for interventions to reduce the subsequent risk of infection.

Risk factors for recurrent carbapenem resistant Klebsiella pneumoniae bloodstream infection: a prospective cohort study

2017 ◽  
Vol 36 (10) ◽  
pp. 1965-1970 ◽  
Author(s):  
Maddalena Giannella ◽  
Elena Graziano ◽  
Lorenzo Marconi ◽  
Nicolo Girometti ◽  
Michele Bartoletti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Klebsiella Pneumoniae ◽  
Bloodstream Infection ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Carbapenem Resistant

scholarly journals Clinical Characteristics and Risk Factors for Bloodstream Infection due to Carbapenem-Resistant Klebsiella Pneumoniae in Patients with Hematologic Malignancies

2020 ◽  
Author(s):  
Piaopiao Zhang ◽  
Jie Wang ◽  
Hangbin Hu ◽  
Sheng Zhang ◽  
Juying Wei ◽  
...  
Keyword(s):  
Risk Factors ◽  
Klebsiella Pneumoniae ◽  
Bloodstream Infection ◽  
Hematologic Malignancy ◽  
Invasive Mechanical Ventilation ◽  
Hematologic Malignancies ◽  
Severe Neutropenia ◽  
Total Risk ◽  
Retrospective Case ◽  
Carbapenem Resistant

Abstract Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) associated infections are a major threat to patient safety. Methods: A single-center, retrospective case-control study representing 734 patients with hematologic malignancies between January 1, 2017 and December 31, 2018 was conducted. Demographic and clinical data were collected from the hospital electronic medical records system. Results: Among the 734 patients with hematologic malignancies, 3% (22/734) of the patients developed CRKP BSI during their hospitalization. Overall 28-day all-cause mortality reached 77.3% (17/22). Patients with Pitt Bacteremia Score (PBS) >4, pneumonia and septic shock were more frequent in the non-survivors versus the survivors . Compared with the non-survivors in antimicrobial treatment, combination therapy of tigecycline and polymyxin B was more common in the survivors. The independent risk factors associated with CRKP BSI were CRKP rectal colonization (OR,11.067; CI=4.43-27.644; P<0.001; 3 points), severe neutropenia (OR,4.095; CI=0.876-19.141; P=0.073; 1 point) and invasive mechanical ventilation (IMV) within the previous 30 days to onset of BSI (OR,18.444; CI=1.787-190.343; P=0.014; 4 points). The total risk score of ≥5 indicated that the probability of CRKP BSI occurrence was above 48%. Conclusions: CRKP BSI in patients with hematologic malignancies is associated with high mortality. The risk factor–based prediction model might help clinicians to start prompt effective anti-infective therapy in patients with suspicion of CRKP BSI and improve outcomes. Keywords: Carbapenem-resistant Klebsiella pneumoniae ; bloodstream infection; hematologic malignancy; risk factors; prediction

High Mortality from Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infection

2021 ◽  
Author(s):  
Luana Soares de Moraes ◽  
Gerusa Luciana Gomes Magalhaes ◽  
João Gabriel Material Soncini ◽  
Marsileni Pelisson ◽  
Marcia Regina Eches Perugini ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Bloodstream Infection ◽  
High Mortality ◽  
Carbapenem Resistant
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