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Epidemiology of Klebsiella pneumoniae bloodstream infections in a teaching hospital: factors related to the carbapenem resistance and patient mortality.

Abstract

BACKGROUND

Although Klebsiella pneumoniae bloodstream infections (KP-BSIs) have recently attracted attention due to an alarming raise in morbidity and mortality, there have been few reports on the epidemiology of KP-BSIs in mainland China. We sought to describe the epidemiological, microbiological, and clinical characteristics of KP-BSIs, focusing on the risk factors of carbapenem resistance and patient mortality.

METHODS

A retrospective analysis of WHONET data of KP-BSI patients admitted to a teaching hospital in Shanghai, China, between January 1, 2011 and December 31, 2015 was performed, and the annual percentage of patients with carbapenem-resistant K. pneumoniae (CRKP) was determined. Risk factors related to the carbapenem resistance and patient mortality were analyzed using binary logistic regression model. The genetic relatedness of CRKP strains isolated from intensive care unit (ICU) patients was determined by pulsed-field gel electrophoresis (PFGE).

RESULTS

A total of 293 incidences of KP-BSIs were identified in a 5-year period, 22.18% of these (65/293) were CRKP strains, and the proportion of CRKP-BSI in ICU was 59.62% (31/52), equaling the levels observed in the epidemic regions. A number of KP-BSIs (114), obtained from January 1, 2014, to December 31, 2015, were further investigated. Skin and soft tissue infection source (odds ratio [OR] 26.63, 95% confidence interval [CI] 4.8-146.8) and ICU-acquired infection (OR 5.82, 95% CI 2.0-17.2) was shown to be powerful risk factors leading to the development of CRKP-BSI. The crude 28-day mortality rates of KP-BSI and CRKP-BSI patients were 22.8% and 33.3%, respectively. Lung as the probable source of infection (OR 4.23, 95% CI 1.0-17.3), and high Sequential Organ Failure Assessment (SOFA) score (OR 1.40, 95% CI 1.2-1.6) were strong prognostic factors determining crude 28-day KP-BSI mortality rates. PFGE analysis demonstrated that 10/11 random CRKP isolates in ICU belonged to the same clonal type.

CONCLUSIONS

During the study period, we observed a significant increase in the occurrence of CRKP infections among the identified KP-BSIs in our hospital and especially in ICU, and we demonstrated that carbapenem resistance is associated with the increased mortality of KP-BSI patients.

Authors+Show Affiliations

Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin ER Road, Shanghai, 200025 China.Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin ER Road, Shanghai, 200025 China.Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin ER Road, Shanghai, 200025 China.Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin ER Road, Shanghai, 200025 China.Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin ER Road, Shanghai, 200025 China.Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin ER Road, Shanghai, 200025 China.Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin ER Road, Shanghai, 200025 China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27891222

Citation

Tian, Lijun, et al. "Epidemiology of Klebsiella Pneumoniae Bloodstream Infections in a Teaching Hospital: Factors Related to the Carbapenem Resistance and Patient Mortality." Antimicrobial Resistance and Infection Control, vol. 5, 2016, p. 48.
Tian L, Tan R, Chen Y, et al. Epidemiology of Klebsiella pneumoniae bloodstream infections in a teaching hospital: factors related to the carbapenem resistance and patient mortality. Antimicrob Resist Infect Control. 2016;5:48.
Tian, L., Tan, R., Chen, Y., Sun, J., Liu, J., Qu, H., & Wang, X. (2016). Epidemiology of Klebsiella pneumoniae bloodstream infections in a teaching hospital: factors related to the carbapenem resistance and patient mortality. Antimicrobial Resistance and Infection Control, 5, p. 48. doi:10.1186/s13756-016-0145-0.
Tian L, et al. Epidemiology of Klebsiella Pneumoniae Bloodstream Infections in a Teaching Hospital: Factors Related to the Carbapenem Resistance and Patient Mortality. Antimicrob Resist Infect Control. 2016;5:48. PubMed PMID: 27891222.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Epidemiology of Klebsiella pneumoniae bloodstream infections in a teaching hospital: factors related to the carbapenem resistance and patient mortality. AU - Tian,Lijun, AU - Tan,Ruoming, AU - Chen,Yang, AU - Sun,Jingyong, AU - Liu,Jialin, AU - Qu,Hongping, AU - Wang,Xiaoli, Y1 - 2016/11/17/ PY - 2016/08/17/received PY - 2016/10/26/accepted PY - 2016/11/29/entrez PY - 2016/11/29/pubmed PY - 2016/11/29/medline KW - Bloodstream infection KW - Carbapenem resistance KW - Epidemiology KW - Klebsiella pneumoniae KW - Mortality SP - 48 EP - 48 JF - Antimicrobial resistance and infection control JO - Antimicrob Resist Infect Control VL - 5 N2 - BACKGROUND: Although Klebsiella pneumoniae bloodstream infections (KP-BSIs) have recently attracted attention due to an alarming raise in morbidity and mortality, there have been few reports on the epidemiology of KP-BSIs in mainland China. We sought to describe the epidemiological, microbiological, and clinical characteristics of KP-BSIs, focusing on the risk factors of carbapenem resistance and patient mortality. METHODS: A retrospective analysis of WHONET data of KP-BSI patients admitted to a teaching hospital in Shanghai, China, between January 1, 2011 and December 31, 2015 was performed, and the annual percentage of patients with carbapenem-resistant K. pneumoniae (CRKP) was determined. Risk factors related to the carbapenem resistance and patient mortality were analyzed using binary logistic regression model. The genetic relatedness of CRKP strains isolated from intensive care unit (ICU) patients was determined by pulsed-field gel electrophoresis (PFGE). RESULTS: A total of 293 incidences of KP-BSIs were identified in a 5-year period, 22.18% of these (65/293) were CRKP strains, and the proportion of CRKP-BSI in ICU was 59.62% (31/52), equaling the levels observed in the epidemic regions. A number of KP-BSIs (114), obtained from January 1, 2014, to December 31, 2015, were further investigated. Skin and soft tissue infection source (odds ratio [OR] 26.63, 95% confidence interval [CI] 4.8-146.8) and ICU-acquired infection (OR 5.82, 95% CI 2.0-17.2) was shown to be powerful risk factors leading to the development of CRKP-BSI. The crude 28-day mortality rates of KP-BSI and CRKP-BSI patients were 22.8% and 33.3%, respectively. Lung as the probable source of infection (OR 4.23, 95% CI 1.0-17.3), and high Sequential Organ Failure Assessment (SOFA) score (OR 1.40, 95% CI 1.2-1.6) were strong prognostic factors determining crude 28-day KP-BSI mortality rates. PFGE analysis demonstrated that 10/11 random CRKP isolates in ICU belonged to the same clonal type. CONCLUSIONS: During the study period, we observed a significant increase in the occurrence of CRKP infections among the identified KP-BSIs in our hospital and especially in ICU, and we demonstrated that carbapenem resistance is associated with the increased mortality of KP-BSI patients. SN - 2047-2994 UR - https://www.unboundmedicine.com/medline/citation/27891222/Epidemiology_of_Klebsiella_pneumoniae_bloodstream_infections_in_a_teaching_hospital:_factors_related_to_the_carbapenem_resistance_and_patient_mortality_ L2 - https://aricjournal.biomedcentral.com/articles/10.1186/s13756-016-0145-0 DB - PRIME DP - Unbound Medicine ER -