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 language | English |
|---|---|
| Pages (from-to) | 54-58 |
| Number of pages | 5 |
| Journal | Journal of Hospital Infection |
| Volume | 78 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - May 2011 |
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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 journal › Article
}
TY - JOUR
T1 - Risk factors and clinical significance of ertapenem-resistant Klebsiella pneumoniae in hospitalised patients
AU - Orsi, G. B.
AU - García-Fernández, A.
AU - Giordano, A.
AU - Venditti, C.
AU - Bencardino, A.
AU - Gianfreda, R.
AU - Falcone, M.
AU - Carattoli, A.
AU - Venditti, M.
PY - 2011/5
Y1 - 2011/5
N2 - 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.
AB - 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.
KW - Ertapenem resistance
KW - Klebsiella pneumoniae
KW - Risk factors
UR - http://www.scopus.com/inward/record.url?scp=79954598745&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79954598745&partnerID=8YFLogxK
U2 - 10.1016/j.jhin.2011.01.014
DO - 10.1016/j.jhin.2011.01.014
M3 - Article
C2 - 21450365
AN - SCOPUS:79954598745
VL - 78
SP - 54
EP - 58
JO - Journal of Hospital Infection
JF - Journal of Hospital Infection
SN - 0195-6701
IS - 1
ER -