scholarly journals Surveillance of carbapenem-resistant Klebsiella pneumoniae in Chinese hospitals - A five-year retrospective study

2019 ◽  
Vol 13 (12) ◽  
pp. 1101-1107 ◽  
Author(s):  
Xiaoyuan Qu ◽  
Haipeng Wang ◽  
Chaoran Chen ◽  
Zhimin Tao ◽  
Chang Yin ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Bacterial Resistance ◽  
Eastern China ◽  
Antibiotic Consumption ◽  
Western China ◽  
Defined Daily Dose ◽  
Carbapenem Resistant ◽  
Consumption Data ◽  
Central Regions ◽  
Tertiary Hospitals

Introduction: Antibiotic consumption is associated with the development of antibiotic resistance. Our aim was to study the relationship between antibiotic consumption and carbapenem-resistant Klebsiella pneumoniae (CRKP) in three public general tertiary hospitals from 2011-2015 in the eastern, western and central regions of China. Methodology: Valid data were collected quarterly, and the antibiotic consumption data were expressed as the defined daily dose (DDD) per 100 inpatient days (ID). Bacterial resistance was reported as the percentage of resistant isolates among all tested isolates. Individual trends were calculated by linear regression, while possible correlations between antibiotic consumption and CRKP were evaluated by distributed lags time series analysis. Results: Over the 5-year period, an overall significant increasing trend (P < 0.1, R2 > 0.3) of carbapenems consumption and the prevalence of CRKP was observed in all three hospitals. This correlated with the use of ceftazidime, cefoperazone/sulbactam, cefminox and meropenem at a hospital in eastern China, with the increased use of meropenem at a hospital in eentral China and with the increased use of doxycycline, ceftriaxone, ceftazidime, meropenem and biapenem at a hospital in western China. Conclusions: We report a high incidence of CRKP in all three hospitals and that an increase in carbapenem usage is associated with this. Further research is needed to elucidate which factors influence the increased consumption of carbapenems.

scholarly journals Epidemiology and clinical significance of pLVPK-like virulence plasmid in KPC-2-producing Klebsiella pneumoniae infections in eastern China: a preliminary exploration

2020 ◽  
Author(s):  
Min Xu ◽  
Qing Yang ◽  
Yanchao Liu ◽  
Xiao Chen ◽  
Haishen Kong ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Clinical Characteristics ◽  
Eastern China ◽  
Multivariable Analysis ◽  
Tertiary Hospital ◽  
Multivariable Logistic Regression Analysis ◽  
Virulence Plasmid ◽  
Carbapenem Resistant ◽  
Epidemiological Trend ◽  
Wide Dissemination

Abstract Background: By acquiring a pLVPK-like virulence plasmid (pVir), Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-kp) evolves to a hypervirulent variant, with increasing cases reported worldwide. However, little is known about the epidemiological trend of pVir in KPC-kp, as well as clinical characteristics of infections caused by this novel strain (pVir+-KPC-kp). Methods: From 2014-2018, 662 carbapenem-resistant K. pneumoniae (CRKP) were consecutively collected from a tertiary hospital of eastern China. The confirmed KPC-kp were subjected to antimicrobial susceptibility testing, multilocus sequence typing and detection of pLVPK-related genetic loci (rmpA, rmpA2, iucA and iroN) to identify pVir+-KPC-kp strains. Then, the clinical characteristics and outcomes of KPC-kp infection patients with and without pVir were compared. Moreover, the risk factors for pVir+-KPC-kp infections also determined by a multivariable logistic regression analysis.Results: of the 662 CRKP, 86.6% (573/662) were KPC-kp including 285 (49.7%) pVir+-KPC-kp and 288 (50.3%) pVir--KPC-kp. Notably, the prevalence of pVir+-KPC-kp by year increased remarkably from 2014 (19.5%, 8/41) to 2018 (60.0%, 90/150). Sequence type (ST) 11 was the most predominant ST, accounting for 88.9% of all pVir+-KPC-kp. For the 352 KPC-kp infection cases (186 with pVir+-KPC-kp and 166 with pVir--KPC-kp), multivariable analysis indicated neurosurgery (Odds ratio [OR], 2.92; 95% confidence interval [CI], 1.48-5.75; P =0.002) was independently associated with pVir+-KPC-kp infections. Although patients with pVir+-KPC-kp infections had higher incidence of septic shock (31.2% vs. 21.1%, P =0.03), the two groups showed no significant differences in 7-day mortality (23.1% vs. 18.1%, P =0.24) or 28-day mortality (45.7% vs. 44.0%, P =0.75). Conclusions: Altogether, wide dissemination of pVir in ST11 KPC-kp has emerged in China. Neurosurgery is an independent risk factor for acquisition of pVir+-KPC-kp infections. The mortality rates were similar between patients infected with pVir+-KPC-kp or pVir--KPC-kp, suggesting uncertain impact of pVir in clinical outcome.

scholarly journals Molecular Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae Infections in Southwest China

2020 ◽  
Author(s):  
Xiaopin Hu ◽  
Guohang Yuan ◽  
Yaoyao Wu ◽  
Weijia Liu ◽  
Xiangyan Zhang ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Southwest China ◽  
Antibiotic Use ◽  
Resistance Mechanisms ◽  
Control Measures ◽  
Invasive Procedures ◽  
Carbapenem Resistant ◽  
Tertiary Hospitals ◽  
Resistance Rates ◽  
Epidemiological Characteristics

Abstract Background: We determined epidemiological characteristics and resistance mechanisms of carbapenem-resistant Klebsiella pneumoniae (CRKP) strains found in Southwest China and assessed disease burden to provide evidence-based strategies for control and treatment of CRKP infection. Methods: A total of 159 strains of CRKP were isolated from sputa, blood, urine, ascites and wound secretions from three tertiary hospitals in Southwest China between August 1st, 2018 and December 31st, 2019. The sensitivity of each strain to 12 antibiotic agents was determined by micro-broth dilution. Identification of carbapenemase genes and multi-locus sequence typing (MLST) were performed using polymerase chain reaction (PCR). The disease burdens of patients with CRKP were assessed based on invasive procedures, antibiotic use, laboratory tests and clinical outcomes. Results: Of 159 CRKP strains analyzed, 50.9% were isolated from sputum samples. The percentage of patients who underwent invasive procedures before positive cultures for CRKP were detected was 96.3%. The mortality of blood infection was highest (66.6%) among patients with CRKP infection. All strains were insensitive to carbapenems. The resistance rates to levofloxacin and amikacin were 85.5% and 81.8%, respectively. All CRKP strains produced carbapenemases, with a majority of isolates (81.1%) producing KPC-2. The MICs of strains harbouring both KPC-2 and NDM-1 were higher than those of strains with only KPC-2 or NDM-1. ST11 is the most popular clonotype found in Southwest China. Conclusions: CRKP strains in Southwest China are characterized by strong drug resistance and associated with poor clinical prognoses. It is therefore urgent to both strengthen control measures and improve prevention awareness.

scholarly journals Regional Inequality of Firms’ Export Opportunity in China: Geographical Location and Economic Openness

2019 ◽  
Vol 12 (1) ◽  
pp. 9
Author(s):  
Peixin Li ◽  
Lixia Li ◽  
Xueliang Zhang
Keyword(s):  
Eastern China ◽  
Geographical Location ◽  
Western China ◽  
Western Region ◽  
Eastern Region ◽  
Land Area ◽  
Economic Openness ◽  
Productivity Level ◽  
Central Regions ◽  
Obvious Inequality

China has a large land area and uneven regional development. There are significant disparities between the three belts (eastern, central, and western China), with the eastern region being the most developed and the western region the least developed. Considering that export is regarded as one of the troikas for China’s economic growth and firms are the basic entities engaged in trade activities, we examine whether there exists inequality of firms’ export opportunity between the three regions. We find that the critical productivity level of firms’ export in developed eastern China is significantly lower than that of western and central regions. Our results indicate that firms in eastern China are more likely to export and there is an obvious inequality of firms’ exporting opportunities.

scholarly journals Mathematical Model To Quantify the Effects of Risk Factors on Carbapenem-Resistant Acinetobacter baumannii

2014 ◽  
Vol 58 (9) ◽  
pp. 5239-5244 ◽  
Author(s):  
Michelle W. Tan ◽  
David C. Lye ◽  
Tat-Ming Ng ◽  
Michael Nikolaou ◽  
Vincent H. Tam
Keyword(s):  
Risk Factors ◽  
Linear Regression ◽  
Acinetobacter Baumannii ◽  
Antibiotic Consumption ◽  
Model Fit ◽  
Defined Daily Dose ◽  
Content Type ◽  
Carbapenem Resistant ◽  
The Impact ◽  
Over Time

ABSTRACTCarbapenem-resistantAcinetobacter baumannii(CRAB) infections are increasing, and they are associated with an increased risk of mortality in hospitalized patients. Linear regression is commonly used to identify concurrent trends, but it cannot quantify the relationship between risk factors and resistance. We developed a model to quantify the impact of antibiotic consumption on the prevalence of CRAB over time. Data were collected from January 2007 to June 2013 from our institution. Quarterly antibiotic consumption was expressed as defined daily dose/1,000 inpatient days. Six-month prevalence of CRAB was expressed as a percentage of all nonrepeatA. baumanniiisolates tested. Individual trends were identified using linear regression. Antibiotic consumption from 2007 to 2011 was input as a step function in a relationship with CRAB. Model fit was evaluated by visual inspection and the residual sum of squares. The final model was validated using the best-fit (95% confidence interval) parameter estimates and antibiotic consumption to predict CRAB prevalence from January 2012 to June 2013. Cefepime, ertapenem, and piperacillin-tazobactam consumption and CRAB prevalence increased significantly over time. CRAB prevalence was best correlated to ertapenem (use sensitive;r2= 0.76), and accounting for additional concurrent antibiotic use did not significantly improve model fit. Prospective validation with ertapenem consumption correlated well with CRAB observations, suggesting good predicting ability of the model. Our model provided the quantitative impact of antibiotic consumption on CRAB. We plan to further refine this model to account for multiple risk factors. Interventions should focus on controlling risk factors with the highest impact on resistance.

Molecular epidemiologic factors contributing to quinolone resistance in clinical multidrug-resistant Klebsiella pneumoniae isolates from Shanghai, China

2021 ◽  
Author(s):  
Yan Wang ◽  
Guoping Cai ◽  
Jinan Zhang ◽  
Xiaogang Xu ◽  
Hongzhou Lu
Keyword(s):  
Klebsiella Pneumoniae ◽  
Point Source ◽  
Bacterial Resistance ◽  
Multidrug Resistant ◽  
Resistance Rate ◽  
Quinolone Resistance ◽  
Epidemiologic Factors ◽  
Selective Pressures ◽  
Carbapenem Resistant ◽  
Epidemiologic Surveillance

Abstract BackgroundThe soaring quinolone-resistance rate of Klebsiella pneumoniae, a common pathogen in immunocompromised individuals, has seriously undermined the wide applications of antimicrobials of this class. This study aimed to investigate the emerging key contributors to quinolone-resistance in multidrug resistant K. pneumoniae (MDR-KP) isolates from a clinical setting with continuing point-source infection outbreaks in Shanghai, China. ResultsBetween January and March 2017, a total of 34 K. pneumoniae isolates, including 30 carbapenem-resistant K. pneumoniae (CRKP), were selected and characterized from a teaching hospital participating in an ongoing Bacterial Resistance Surveillance Project in Shanghai, China. Two predominant high-risk CRKP clones, ST11-wzi64 and ST15-wzi19/wzi24, caused three point-source nosocomial outbreaks in intensive care unit and/or neurosurgery department potentially by respiratory-route, promoting the co-selection and evolution of multidrug-resistant determinants. Multiple quinolone resistance-determining region (QRDR) mutations occurred in isolates of ST15 (S83F, D87A; S80I), ST11 (S83I, D87G; S80I), and ST218 (D87A; S80I). Plasmid-mediated quinolone resistance determinants, qnrS1, aac(6’)-Ib-cr, oqxAB, were detected in 32 (94.1%) isolates alone or in combination, spreading accompanied with β-lactamases (mainly, KPC-2-type carbapenemase and CTX-M-type extended-spectrum β-lactamase), 16S rRNA methylases (ArmA and RmtB), and putrescine ABC transporter permease (PotI) variants, independently of QRDR-mutations. AcrR, AcrAB transcriptional repressor, was insertion-inactivated by IS5-transposase in isolates of ST11. Thirteen ompK36 variants associated with specific ST (n=7) and wzi-allele (n=9) clustered into 10 (sub)lineages in the phylogenetic tree possibly affecting the MDR phenotype and the infection outcome of isolates. Isolates of ST11, ST15, and ST218 had frameshift disruptions in OmpK35 coupled with specific GD-insertion at position 134-135 in OmpK36, all showing distinct microevolution clusters of ompK36 genotypes. Seven quinolone-susceptible isolates kept the porin genes integral, including two each CRKPs of ST13-wzi74 (carbapenemase KPC-2 and NDM-1-coproducers) and ST65-wzi72. ConclusionsUnder selective pressures, accumulation of mutations of three types (QRDR, AcrR, OmpK36/OmpK35) and acquisition of resistance-conferring genes has been continuously contributing to quinolone-resistance in clinical MDR-KP isolates, reinforcing the importance of ongoing epidemiologic surveillance on the evolution and transmission of these isolates. Our findings provided detailed mechanistic analyses and epidemiologic implications for further infection control and antibiotic stewardship initiatives.

Antimicrobial Consumption and Multidrug Resistant Organisms in Intensive Care Units

2015 ◽  
pp. 209-240
Author(s):  
Fouad Farouk Jabri
Keyword(s):  
Public Health ◽  
Bacterial Resistance ◽  
Antimicrobial Agents ◽  
Multidrug Resistant ◽  
Public Health Issue ◽  
Defined Daily Dose ◽  
Antimicrobial Consumption ◽  
Consumption Data ◽  
Unit Of Measurement ◽  
And Control

Improper antimicrobial use and bacterial resistance can affect an entire community, threaten public health and create economic burdens and ecological consequences on societies. This chapter discusses the importance of counteracting this public health issue. In Saudi Arabia, the appropriate use of antimicrobial agents is of particular concern. The prescribing of broad-spectrum antimicrobials in hospital settings is not highly restricted, and antimicrobials are available over the counters in pharmacies. This unwise use provides a scenario for the emergence of bacterial resistance and subsequent public health concerns. In addition, there is a lack of representative epidemiological research on antimicrobial consumption and quantitative data linking consumption to the incidence of resistance. This chapter illustrates that the implementation and the success of the strategies that monitor and control antimicrobial consumption depend on the availability of information about the extent and patterns of antimicrobial consumption. It demonstrates the potentials and recommendations on obtaining antimicrobial consumption data using defined daily dose as a unit of measurement in Saudi hospital settings.

scholarly journals Hazai kórházi antibiotikum-alkalmazás az elmúlt két évtizedben (1996–2015)

2016 ◽  
Vol 157 (46) ◽  
pp. 1839-1846 ◽  
Author(s):  
Ria Benkő ◽  
Mária Matuz ◽  
Edit Hajdú ◽  
Andrea Bor ◽  
Péter Doró ◽  
...  
Keyword(s):  
Bacterial Resistance ◽  
Anatomical Therapeutic Chemical ◽  
Antibiotic Use ◽  
Generation Cephalosporin ◽  
Defined Daily Dose ◽  
Future Studies ◽  
International Benchmarking ◽  
Consumption Data ◽  
Daily Dose ◽  
Parenteral Products

Introduction: Growing bacterial resistance threatens public health, which can be tempered by prudent antibiotic use. Aim: To quantify systemic antibacterial use in Hungarian hospitals. Method: Consumption data were analysed using the Anatomical-Therapeutic-Chemical – Defined Daily Dose (ATC/DDD) methodology. Data were standardized for patient turnover and also for population to enable international benchmarking. Results: Hospital antibiotic use was quite constant (22.4 ± 1.5 DDD/100 patient-days), but its composition changed substantially. The use of parenteral products rose gradually (in 1996 26.4% and in 2015 41.6%). The pattern of use was homogenised due to the headway of co-amoxiclav use. A substantial increase of fluoroquinolone (2.3 vs. 4.2 DDD/100 patient-days) and third generation cephalosporin (1.0 vs. 2.9 DDD/100 patient-days) use was detected. In parallel the use of narrow spectra penicillins diminished. Conclusion: Hungarian hospital antibiotic use is low. The causes and the justification of this low use together with the internationally outstanding use of certain antibacterials should be addressed in future studies. Orv. Hetil., 2016, 157(46), 1839–1846.

Sign in / Sign up

Export Citation Format

Share Document