Risk factors and clinical significance of ertapenem-resistant Klebsiella pneumoniae in hospitalised patients

G. B. Orsi, A. García-Fernández, A. Giordano, C. Venditti, A. Bencardino, R. Gianfreda, M. Falcone, A. Carattoli, M. Venditti

Research output: Contribution to journalArticle

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Abstract

Ertapenem-resistant Klebsiella pneumoniae (ER-Kp) is an emerging healthcare-associated pathogen. In order to identify risk factors associated with ER-Kp acquisition, the records of 100 patients from whom K. pneumoniae had been isolated between July 2008 and December 2009 were reviewed. These comprised 38 with ER-Kp (28 infected, 10 colonised) and 62 with ertapenem-susceptible K. pneumoniae (ES-Kp) (43 infected, 19 colonised). Multilocus sequence typing (MSLT) and porin gene investigation performed on 25 ER-Kp strains showed that 24 belonged to the ST37 lineage, expressing a novel OmpK36 variant and not expressing OmpK35. Breakthrough bacteraemia occurred in 13 (52%) of 25 bloodstream infections (BSIs). Among nine ER-Kp BSIs, five were complicated by breakthrough bacteraemia, of which four developed during carbapenem therapy. Among 16 ES-Kp BSIs, breakthrough bacteraemia developed in eight patients (50%), but only one occurred (12%) during carbapenem therapy. Logistic regression analysis showed that carbapenems (odds ratio: 12.9; 95% confidence interval: 3.09-53.7; P<0.001), second generation cephalosporins (11.8; 1.87-74.4; P<0.01), endoscopy (5.59; 1.32-23.6; P<0.02), acute renal failure (5.32; 1.13-25.1; P= 0.034) and third generation cephalosporins (4.15; 1.09-15.8; P<0.01) were independent risk factors for acquisition of ER-Kp. Our findings confirm that prior use of certain antimicrobials, specifically carbapenems and cephalosporins, are primary independent risk factors for colonisation or infection with ER-Kp.

Original languageEnglish
Pages (from-to)54-58
Number of pages5
JournalJournal of Hospital Infection
Volume78
Issue number1
DOIs
Publication statusPublished - May 2011

Fingerprint

Klebsiella pneumoniae
Carbapenems
Cephalosporins
Bacteremia
Infection
Multilocus Sequence Typing
Porins
ertapenem
Acute Kidney Injury
Endoscopy
Logistic Models
Odds Ratio
Regression Analysis
Confidence Intervals
Delivery of Health Care
Therapeutics
Genes

Keywords

  • Ertapenem resistance
  • Klebsiella pneumoniae
  • Risk factors

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Risk factors and clinical significance of ertapenem-resistant Klebsiella pneumoniae in hospitalised patients. / Orsi, G. B.; García-Fernández, A.; Giordano, A.; Venditti, C.; Bencardino, A.; Gianfreda, R.; Falcone, M.; Carattoli, A.; Venditti, M.

In: Journal of Hospital Infection, Vol. 78, No. 1, 05.2011, p. 54-58.

Research output: Contribution to journalArticle

Orsi, GB, García-Fernández, A, Giordano, A, Venditti, C, Bencardino, A, Gianfreda, R, Falcone, M, Carattoli, A & Venditti, M 2011, 'Risk factors and clinical significance of ertapenem-resistant Klebsiella pneumoniae in hospitalised patients', Journal of Hospital Infection, vol. 78, no. 1, pp. 54-58. https://doi.org/10.1016/j.jhin.2011.01.014
Orsi, G. B. ; García-Fernández, A. ; Giordano, A. ; Venditti, C. ; Bencardino, A. ; Gianfreda, R. ; Falcone, M. ; Carattoli, A. ; Venditti, M. / Risk factors and clinical significance of ertapenem-resistant Klebsiella pneumoniae in hospitalised patients. In: Journal of Hospital Infection. 2011 ; Vol. 78, No. 1. pp. 54-58.
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abstract = "Ertapenem-resistant Klebsiella pneumoniae (ER-Kp) is an emerging healthcare-associated pathogen. In order to identify risk factors associated with ER-Kp acquisition, the records of 100 patients from whom K. pneumoniae had been isolated between July 2008 and December 2009 were reviewed. These comprised 38 with ER-Kp (28 infected, 10 colonised) and 62 with ertapenem-susceptible K. pneumoniae (ES-Kp) (43 infected, 19 colonised). Multilocus sequence typing (MSLT) and porin gene investigation performed on 25 ER-Kp strains showed that 24 belonged to the ST37 lineage, expressing a novel OmpK36 variant and not expressing OmpK35. Breakthrough bacteraemia occurred in 13 (52{\%}) of 25 bloodstream infections (BSIs). Among nine ER-Kp BSIs, five were complicated by breakthrough bacteraemia, of which four developed during carbapenem therapy. Among 16 ES-Kp BSIs, breakthrough bacteraemia developed in eight patients (50{\%}), but only one occurred (12{\%}) during carbapenem therapy. Logistic regression analysis showed that carbapenems (odds ratio: 12.9; 95{\%} confidence interval: 3.09-53.7; P<0.001), second generation cephalosporins (11.8; 1.87-74.4; P<0.01), endoscopy (5.59; 1.32-23.6; P<0.02), acute renal failure (5.32; 1.13-25.1; P= 0.034) and third generation cephalosporins (4.15; 1.09-15.8; P<0.01) were independent risk factors for acquisition of ER-Kp. Our findings confirm that prior use of certain antimicrobials, specifically carbapenems and cephalosporins, are primary independent risk factors for colonisation or infection with ER-Kp.",
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