Clinical characteristics and prognosis of carbapenem-resistant <i>Klebsiella</i> pneumoniae infection of critical patients_Chinese Journal of Evidence-Based Medicine

Authors：

LI Hui ^1,2 , ZHENG Yao ^1,2 , YANG Xiang ^1,2 , ZHANG Pingjie ^1,2 , XIAO Wenyan ^1,2 ,  YANG Min ^1,2

1. Department of Intensive Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, P.R.China;
2. Department of Cardiopulmonary Resuscitation and Critical Care Laboratory, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, P.R.China;

Corresponding author：

YANG Min, Email: 456ym@163.com

Keywords：

Carbapenem-resistant Klebsiella pneumonia; Bacteria resistance; Clinical characteristics; Risk factor; Prognosis

DOI：

10.7507/1672-2531.201809113

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Objectives To identify the clinical characteristics and prognosis for CRKP (Carbapenem-resistant Klebsiella pneumonia, CRKP) infection among ICU patients in the Second Affiliated Hospital of Anhui Medical University. Methods We conducted a retrospectively analysis in which 19 patients infected by CRKP with another 21 CSKP (Carbapenem-sensitive Klebsiella pneumoniae, CSKP) infected patients from January 2017 to April 2018. Risk factors for CRKP infection were assessed. Results The lower respiratory tract is the most common site of CRKP infection in our department. CRKP infection was associated with several clinical symptoms, particularly a higher incidence of sepsis shock (χ²=8.338, P=0.004), more application of the combined medicine (χ²=26.3, P<0.001), prolonged hospital stays (χ²=–2.217, P=0.027) and more expenses on antibiotics (χ²=12.855, P=0.005), and the declined survival rates in 14 days (χ²=4.269, P=0.039) and 21 days (χ² =5.647, P=0.017). The resistance rate of CRKP strains was high, however no resistance to tegafycline was found. The risk factors of CRKP infection included three generations of cephalosporin and/or hydrocarbonase antibiotics exposure (χ² =6.388, P=0.041), exposure time of three generations of cephalosporin (U=–2.187, P=0.029), exposure time of hydrocarbonase antibiotics (U=–2.103, P=0.035), tracheal intubation (χ²=6.352, P=0.012), tracheotomy (χ² =4.821, P=0.028), SOFA score (t=4.505, P<0.001) and Charlson comorbidity index (t=3.041, P=0.004). The SOFA score was the only factor independently associated with CRKP bacteremia (P=0.02). Conclusions CRKP infections in ICU directly affect the course of disease, survival time and treatment expenses of patients. Therefore, monitoring bacterial resistance, rational use of antibiotics, and protection of the immune function are of great significance for prevention and treatment of CRKP infection.

Citation： LI Hui, ZHENG Yao, YANG Xiang, ZHANG Pingjie, XIAO Wenyan, YANG Min. Clinical characteristics and prognosis of carbapenem-resistant Klebsiella pneumoniae infection of critical patients. Chinese Journal of Evidence-Based Medicine, 2019, 19(2): 129-134. doi: 10.7507/1672-2531.201809113 Copy

1.	Theuretzbacher U. Global antimicrobial resistance in gram-negative pathogens and clinical need. Curr Opin Microbiol, 2017, 39: 106-112.
2.	Xu L, Sun X, Ma X. Systematic review and meta-analysis of mortality of patients infected with carbapenem-resistant Klebsiella pneumoniae. Ann Clin Microbiol Antimicrob, 2017, 16(1): 18.
3.	Podschun R, Ullmann U. Klebsiella spp. as nosocomial pathogens: epidemiology, taxonomy, typing methods, and pathogenicity factors. Clin Microbiol Rev, 1988, 11(4): 589-603.
4.	胡付品, 郭燕, 朱德妹, 等. 2017 年 CHINET 中国细菌耐药性监测. 中国感染与化疗杂志, 2018, 18(3): 241-251.
5.	Zhang Z. Univariate description and bivariate statistical inference: the first step delving into data. Ann Transl Med, 2016, 4(5): 91.
6.	Mulroney KT, Hall JM, Huang X, et al. Author correction: rapid susceptibility profiling of carbapenem-resistant Klebsiella pneumoniae. Sci Rep, 2018, 8(1): 6697.
7.	胡志军, 潘晓龙, 周东升, 等. 肺炎克雷伯菌感染的临床分布及耐药性监测. 中华医院感染学杂志, 2014, 24(12): 2865-2867.
8.	Cristina ML, Alicino C, Sartini M, et al. Epidemiology, management, and outcome of c arbapenem-resistant Klebsiella pneumoniae bloodstream infections in hospitals within the same endemic metropolitan area. J Infect Public Health, 2018, 11(2): 171-177.
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10.	Adams-Sapper S, Gayoso A, Riley LW. Stress-adaptive responses associated with high-level carbapenem resistance in KPC-producing Klebsiella pneumoniae. J Pathog, 2018, 2018: 3028290.
11.	Gharbi M, Moore S, Gilchrist M, et al. Forecasting carbapenem resistance from antimicrobial consumption surveillance: lessons learnt from an OXA-48-producing Klebsiella pneumoniae outbreak in a West London renal unit. Int J Antimicrob Agents, 2015, 46(2): 150-156.
12.	Tzouvelekis LS, Markogiannakis A, Piperaki E, et al. Treating infections caused by carbapenemase-producing enterobacteriaceae. Clin Microbiol Infect, 2014, 20(9): 862-872.
13.	Jayol A, Nordmann P, Poirel L, et al. Ceftazidime/avibactam alone or in combination with aztreonam against colistin-resistant and carbapenemase-producing Klebsiella pneumoniae. J Antimicrob Chemother, 2018, 73(2): 542-544.
14.	Lee YR, Baker NT. Meropenem-vaborbactam: a carbapenem and beta-lactamase inhibitor with activity against carbapenem-resistant Enterobacteriaceae. Eur J Clin Microbiol Infect Dis, 2018, 37(8): 1411-1419.
15.	Van Duin D, Lok JJ, Earley M, et al. Colistin versus ceftazidime-avibactam in the treatment of infections due to carbapenem-resistant enterobacteriaceae. Clin Infect Dis, 2018, 66(2): 163-171.
16.	Harris PN, Tambyah PA, Paterson DL. β2-lactam and β2-lactamase inhibitor combinations in the treatment of extended-spectrum β2-lactamase producing enterobacteriaceae: time for a reappraisal in the era of few antibiotic options? Lancet Infect Dis, 2015, 15(4): 475-485.
17.	Band VI, Satola SW, Burd EM, et al. Carbapenem-resistant Klebsiella pneumoniae exhibiting clinically undetected colistin heteroresistance leads to treatment failure in a murine model of infection. MBio, 2018, 9(2): e02448-2517.
18.	Pascale GD, Montini L, Pennisi MA, et al. High dose tigecycline in critically ill patients with severe infections due to multidrug-resistant bacteria. Critical Care, 2014, 18(3): 1-9.
19.	Pletzer D, Coleman SR, Hancock RE. Anti-biofilm peptides as a new weapon in antimicrobial warfare. Curr Opin Microbiol, 2016, 33: 35-40.
20.	WHO. Guidelines for the prevention and control of carbapenem-resistant enterobacteriaceae, acinetobacter baumannii and pseudomonas aeruginosa in health care facilities. Available at: http://apps.who.int/iris/bitstream/handle/10665/259462/9789241550178-eng.pdf;sequence=1.

1. Theuretzbacher U. Global antimicrobial resistance in gram-negative pathogens and clinical need. Curr Opin Microbiol, 2017, 39: 106-112.
2. Xu L, Sun X, Ma X. Systematic review and meta-analysis of mortality of patients infected with carbapenem-resistant Klebsiella pneumoniae. Ann Clin Microbiol Antimicrob, 2017, 16(1): 18.
3. Podschun R, Ullmann U. Klebsiella spp. as nosocomial pathogens: epidemiology, taxonomy, typing methods, and pathogenicity factors. Clin Microbiol Rev, 1988, 11(4): 589-603.
4. 胡付品, 郭燕, 朱德妹, 等. 2017 年 CHINET 中国细菌耐药性监测. 中国感染与化疗杂志, 2018, 18(3): 241-251.
5. Zhang Z. Univariate description and bivariate statistical inference: the first step delving into data. Ann Transl Med, 2016, 4(5): 91.
6. Mulroney KT, Hall JM, Huang X, et al. Author correction: rapid susceptibility profiling of carbapenem-resistant Klebsiella pneumoniae. Sci Rep, 2018, 8(1): 6697.
7. 胡志军, 潘晓龙, 周东升, 等. 肺炎克雷伯菌感染的临床分布及耐药性监测. 中华医院感染学杂志, 2014, 24(12): 2865-2867.
8. Cristina ML, Alicino C, Sartini M, et al. Epidemiology, management, and outcome of c arbapenem-resistant Klebsiella pneumoniae bloodstream infections in hospitals within the same endemic metropolitan area. J Infect Public Health, 2018, 11(2): 171-177.
9. Patel PK, Russo TA, Karchmer AW. Hypervirulent Klebsiella pneumoniae. Open Forum Infect Dis, 2014, 1(1): u28.
10. Adams-Sapper S, Gayoso A, Riley LW. Stress-adaptive responses associated with high-level carbapenem resistance in KPC-producing Klebsiella pneumoniae. J Pathog, 2018, 2018: 3028290.
11. Gharbi M, Moore S, Gilchrist M, et al. Forecasting carbapenem resistance from antimicrobial consumption surveillance: lessons learnt from an OXA-48-producing Klebsiella pneumoniae outbreak in a West London renal unit. Int J Antimicrob Agents, 2015, 46(2): 150-156.
12. Tzouvelekis LS, Markogiannakis A, Piperaki E, et al. Treating infections caused by carbapenemase-producing enterobacteriaceae. Clin Microbiol Infect, 2014, 20(9): 862-872.
13. Jayol A, Nordmann P, Poirel L, et al. Ceftazidime/avibactam alone or in combination with aztreonam against colistin-resistant and carbapenemase-producing Klebsiella pneumoniae. J Antimicrob Chemother, 2018, 73(2): 542-544.
14. Lee YR, Baker NT. Meropenem-vaborbactam: a carbapenem and beta-lactamase inhibitor with activity against carbapenem-resistant Enterobacteriaceae. Eur J Clin Microbiol Infect Dis, 2018, 37(8): 1411-1419.
15. Van Duin D, Lok JJ, Earley M, et al. Colistin versus ceftazidime-avibactam in the treatment of infections due to carbapenem-resistant enterobacteriaceae. Clin Infect Dis, 2018, 66(2): 163-171.
16. Harris PN, Tambyah PA, Paterson DL. β2-lactam and β2-lactamase inhibitor combinations in the treatment of extended-spectrum β2-lactamase producing enterobacteriaceae: time for a reappraisal in the era of few antibiotic options? Lancet Infect Dis, 2015, 15(4): 475-485.
17. Band VI, Satola SW, Burd EM, et al. Carbapenem-resistant Klebsiella pneumoniae exhibiting clinically undetected colistin heteroresistance leads to treatment failure in a murine model of infection. MBio, 2018, 9(2): e02448-2517.
18. Pascale GD, Montini L, Pennisi MA, et al. High dose tigecycline in critically ill patients with severe infections due to multidrug-resistant bacteria. Critical Care, 2014, 18(3): 1-9.
19. Pletzer D, Coleman SR, Hancock RE. Anti-biofilm peptides as a new weapon in antimicrobial warfare. Curr Opin Microbiol, 2016, 33: 35-40.
20. WHO. Guidelines for the prevention and control of carbapenem-resistant enterobacteriaceae, acinetobacter baumannii and pseudomonas aeruginosa in health care facilities. Available at: http://apps.who.int/iris/bitstream/handle/10665/259462/9789241550178-eng.pdf;sequence=1.

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