Epidemic of carbapenem-resistant Klebsiella pneumoniae in Europe is driven by nosocomial spread
Sophia DavidSandra ReuterSimon R. HarrisCorinna GlasnerTheresa FeltwellSilvia ArgimónKhalil AbudahabRichard GoaterTommaso GianiGiulia ErricoMarianne AspburySara SjunneboEdward J. FeilGian María RossoliniDavid M. AanensenHajo GrundmannAndi KoraqiDenada LacejPetra ApfalterRainer HartlY. GlupczynskiTe‐Din HuangTanya StratevaY. Marteva-ProevskaArjana Tambić AndraševićIva ButićDespo Pieridou-BagatzouniPanagiota Maikanti-CharalampousJaroslav HrabákHelena ŽemličkováAnette M. HammerumLotte JakobsenMarina IvanovaAnastasia PavelkovichJari JalavaMonica ÖsterbladLaurent DortetSophie VauxMartin KaaseSoeren G. GatermannAlkiviadis VatopoulosKyriaki TryfinopoulouÁkos TóthLaura JánváriTeck Wee BooElaine McGrathYehuda CarmeliAmos AdlerAnnalisa PantostiMonica MonacoLul RakaArsim KurtiArta BalodeMāra SauleJolanta MiciulevičienėAistė MierauskaitėMonique Perrin-WenigerPaul ReichertNina NestorovaSonia DebattistaGordana MijovićMilena LopičićØrjan SamuelsenBjørg HaldorsenDorota ŻabickaElżbieta LiterackaManuela CaniçaVera ManageiroAna KaftandzievaElena Trajkovska-DokicMaria DamianBrânduşa Elena LixandruZora JelesićAnika TrudićM NikśEva SchréterováMateja PiršTjaša CerarJesús OteoBelén AracilChristian G. GiskeKarin SjöströmDeniz GürAslı ÇakarNeil WoodfordKatie L. HopkinsCamilla WiuffDerek Brown
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Keywords:
Klebsiella infections
Carbapenem
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Klebsiella infections
Klebsiella
Carbapenem
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Colistin
Klebsiella infections
Carbapenem
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Centre Hospitalier Avranches-Granville, Rue des menneries, Granville, France University Hospital of Caen, Caen, France
Klebsiella
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As the clinical application of carbapenem antibiotics, carbapenem-resistant Enterobacteriaceae are widespread, the clinical isolation rate of the carbapenem-resistant Klebsiella pneumoniae increases significantly, which takes a lot of challenges to the clinical treatment and infection control. The article reviews the status of infection, the resistance mechanism, infection detection and treatment progress of carbapenem-resistant Klebsiella pneumoniae.
Key words:
Klebsiella pneumoniae; Carbapenemase; Infection; Detection; Clinical treatment
Carbapenem
Carbapenem-resistant enterobacteriaceae
Klebsiella
Isolation
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Infections with carbapenem-resistant Enterobacteriaceae (CRE) are an emerging problem in hospitals. Klebsiella pneumoniae is the organism most often
Carbapenem-resistant enterobacteriaceae
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Enterobacteriaceae Infections
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ÖZKarbapenem dirençli Enterobacteriaceae üyelerinin neden olduğu enfeksiyonların sıklığı tüm dünyada giderek artmakta olup mortalite oranları oldukça yüksektir.Bu kökenler ile oluşan enfeksiyonların ve kolonize hastaların hızlı tespiti, enfeksiyon kontrol protokollerinin uygulanması açısından oldukça önemlidir.Çalışmamızda erişkin yoğun bakım ünitelerinde yatan hastalarda karbapenem dirençli Klebsiella pneumoniae kökenleri ile gelişen kolonizasyon/enfeksiyon oranları ve karbapenemaz tiplerinin araştırılması amaçlanmıştır.Bu çalışmaya erişkin yoğun bakım ünitelerinde yatan hastalardan
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Bacteremia
Klebsiella infections
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Carbapenem-resistant Klebsiella pneumoniae (CRKP) is emerging as a worldwide public health concern; however, the long-term molecular epidemiological surveillance of clinical CRKP in China is limited. We conducted a retrospective observational study (2008–2018) to assess the prevalence, susceptibility, risk factors and molecular epidemiology of clinical CRKP isolates. We found the prevalence of CRKP increased from 2.5%, 2008 to 15.8%, 2018. CRKP were significantly more frequent among hospitalized patients from ICU, and it was significantly more likely to be isolated from the capital city (Hangzhou) and the patients aged ≥60 years. Additionally, seasons and specimen types were associated with CRKP infections. The main CRKP sequence type (ST) was ST11, and blaKPC-2 was the most prevalent gene variant. Together these data reveal an increasing incidence and resistance trends among CRKP, especially the ST11-blaKPC-2-CRKP, in Zhejiang, during 2008–2018. Our findings are important for hospitals to limit its dissemination and optimize antibiotic administration.
Molecular Epidemiology
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Purpose: Colistin is considered the last resort antibiotic for treating infections caused by carbapenem-resistant bacteria. However, the emergence of colistin resistance emphasizes the urgent need to understand its associated factors. The aim of this study is to identify risk factors for the acquisition of colistin and carbapenem-resistant Klebsiella pneumoniae (CRK) in an endemic region for carbapenem resistance. Methods & Materials: A case-control study enrolling all inpatients infected by CRK between June-2012 and June-2014 in four tertiary-care centers in Medellin-Colombia was conducted. Cases were defined as patients infected by colistin-resistant CRK and controls as patients infected by colistin-susceptible CRK. Sociodemographics and medical history in the past year from the beginning of infection were retrieved from clinical charts. Antibiotic susceptibility testing, multilocus-sequence-typing (MLST) and detection of mcr-1 a plasmid-mediated colistin resistance gene were performed. A bivariate and multivariate analysis using generalized estimating equations were implemented to account for the intra-class correlation within hospitals. Results: A total 32 cases and 129 controls were enrolled. Most patients were males (63.4%) and all were adults (median=54 years, IQR 35–70). Frequent infections were urinary tract (28.7%), bloodstream (23.1%) and intra-abdominal infections (19.4%). MLST showed high heterogeneity among colistin-susceptible CRK, while colistin-resistant CRK belonged mostly to CG258 (84%). Detection of mcr-1 was negative in all resistant strains. Bivariate analysis showed patients with longer hospitalization were more likely to be infected by colistin-resistant CRK (23% risk increase by every 10 days). The strongest risk factors were infection by CG258 (OR=12.01, 95%CI 4.31-33.47) and previous colistin use in the past six months (OR=6.72, 95%CI 1.68–26.75). Factors associated with colistin-resistant CRK in the multivariate analysis were infection by CG258 (OR=17.57, 95%CI 4.93–62.62), previous use of colistin (OR=7.21, 95%CI 1.10–47.01), longer time at risk (coefficient 0.025, 95%CI 0.006–0.044) and mechanical ventilation (OR=3.43, 95%CI 1.11–10.66). Conclusion: Infection by CG258 and previous use of colistin play an important role in colistin-resistant CRK acquisition. The emergence of resistance in this clone is worrisome due to its international spread and the paucity of therapeutics options for its treatment. Our findings suggest both infection-control practices and stewardship programs are essential to control infections by colistin-resistant CRK.
Colistin
Multilocus sequence typing
Carbapenem
Adapter molecule crk
MCR-1
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