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The Colonization of Carbapenem-Resistant Klebsiella pneumoniae: Epidemiology, Resistance Mechanisms, and Risk Factors in Patients Admitted to Intensive Care Units in China.
J Infect Dis. 2020 Mar 16; 221(Supplement_2):S206-S214.JI

Abstract

BACKGROUND

Carbapenem-resistant Klebsiella pneumoniae (CRKP) has become a threat to public health, most notably as a superbug causing nosocomial infections. Patients in the intensive care unit (ICU) are at increased risk of hospital-acquired K pneumoniae infection, especially CRKP. This study was conducted to investigate the frequency of gastrointestinal and nasopharyngeal K pneumoniae colonization and its contribution to infections in ICU patients.

METHODS

A 3-month prospective cohort study was performed in which 243 ICU patients were screened for intestinal and nasopharyngeal carriage of K pneumoniae at admission and once per week thereafter. The colonization and clinical infection isolates were analyzed by antimicrobial susceptibility testing to identify CRKP and were characterized by multilocus sequence typing (MLST) and whole-genome sequencing combined with epidemiological data to investigate the resistance mechanisms and assess the possible transmitted infection.

RESULTS

Twenty-eight percent (68 of 243) of patients tested positive for carriage of K pneumoniae immediately upon admission to ICU, 54% (37 of 68) of which were nonduplicate CRKP isolates. Patients with carbapenem-susceptible K pneumoniae (CSKP) colonization at admission were more likely to acquire CRKP colonization during the ICU stay compared with patients without K pneumoniae colonization at admission. The incidence of subsequent CRKP infection in the baseline CSKP (32.3%, 10 of 31) and CRKP (45.9%, 17 of 37) carrier group was significantly higher than that of the baseline non-KP carrier group (8.6%, 15 of 175). The risk factors associated with acquired CRKP colonization during the ICU stay among negative CRKP colonization at admission included previous exposure to carbapenem, tigecycline or β-lactam/β-lactamases inhibitor, and invasive processes or surgical operations. Sixty-four percent (27 of 42) of patients with K pneumoniae infection were colonized by clonally related K pneumoniae strains according to enterobacterial repetitive intergenic consensus sequence-polymerase chain reaction analysis. ST11 (72%, 53 of 74) was the most predominant MLST type of clonally related CRKP isolate colonizing these patients, followed by ST15 (26%, 19 of 74).

CONCLUSIONS

The colonization of K pneumoniae may increase the incidence of corresponding K pneumoniae infection in critically ill patients in the ICU. High prevalence of ST11 CRKP (due to blaKPC-2) carriage and infection in ICU was observed.

Authors+Show Affiliations

Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China. Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China.Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China. Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China.Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China. Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China.Department of Laboratory Medicine, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Hubei, China.Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China. Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China.Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China. Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China.Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China. Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China.Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China. Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China.Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China. Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China. Infection Control Department, Huashan Hospital, Fudan University, Shanghai, China.Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China. Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32176790

Citation

Qin, Xiaohua, et al. "The Colonization of Carbapenem-Resistant Klebsiella Pneumoniae: Epidemiology, Resistance Mechanisms, and Risk Factors in Patients Admitted to Intensive Care Units in China." The Journal of Infectious Diseases, vol. 221, no. Supplement_2, 2020, pp. S206-S214.
Qin X, Wu S, Hao M, et al. The Colonization of Carbapenem-Resistant Klebsiella pneumoniae: Epidemiology, Resistance Mechanisms, and Risk Factors in Patients Admitted to Intensive Care Units in China. J Infect Dis. 2020;221(Supplement_2):S206-S214.
Qin, X., Wu, S., Hao, M., Zhu, J., Ding, B., Yang, Y., Xu, X., Wang, M., Yang, F., & Hu, F. (2020). The Colonization of Carbapenem-Resistant Klebsiella pneumoniae: Epidemiology, Resistance Mechanisms, and Risk Factors in Patients Admitted to Intensive Care Units in China. The Journal of Infectious Diseases, 221(Supplement_2), S206-S214. https://doi.org/10.1093/infdis/jiz622
Qin X, et al. The Colonization of Carbapenem-Resistant Klebsiella Pneumoniae: Epidemiology, Resistance Mechanisms, and Risk Factors in Patients Admitted to Intensive Care Units in China. J Infect Dis. 2020 Mar 16;221(Supplement_2):S206-S214. PubMed PMID: 32176790.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Colonization of Carbapenem-Resistant Klebsiella pneumoniae: Epidemiology, Resistance Mechanisms, and Risk Factors in Patients Admitted to Intensive Care Units in China. AU - Qin,Xiaohua, AU - Wu,Shi, AU - Hao,Min, AU - Zhu,Jing, AU - Ding,Baixing, AU - Yang,Yang, AU - Xu,Xiaogang, AU - Wang,Minggui, AU - Yang,Fan, AU - Hu,Fupin, PY - 2020/3/17/entrez PY - 2020/3/17/pubmed PY - 2020/3/17/medline KW - carbapenem-resistant K pneumoniae KW - gastrointestinal and nasopharyngeal colonization KW - intensive care units (ICU) KW - multilocus sequence typing (MLST) KW - risk factors of colonization SP - S206 EP - S214 JF - The Journal of infectious diseases JO - J. Infect. Dis. VL - 221 IS - Supplement_2 N2 - BACKGROUND: Carbapenem-resistant Klebsiella pneumoniae (CRKP) has become a threat to public health, most notably as a superbug causing nosocomial infections. Patients in the intensive care unit (ICU) are at increased risk of hospital-acquired K pneumoniae infection, especially CRKP. This study was conducted to investigate the frequency of gastrointestinal and nasopharyngeal K pneumoniae colonization and its contribution to infections in ICU patients. METHODS: A 3-month prospective cohort study was performed in which 243 ICU patients were screened for intestinal and nasopharyngeal carriage of K pneumoniae at admission and once per week thereafter. The colonization and clinical infection isolates were analyzed by antimicrobial susceptibility testing to identify CRKP and were characterized by multilocus sequence typing (MLST) and whole-genome sequencing combined with epidemiological data to investigate the resistance mechanisms and assess the possible transmitted infection. RESULTS: Twenty-eight percent (68 of 243) of patients tested positive for carriage of K pneumoniae immediately upon admission to ICU, 54% (37 of 68) of which were nonduplicate CRKP isolates. Patients with carbapenem-susceptible K pneumoniae (CSKP) colonization at admission were more likely to acquire CRKP colonization during the ICU stay compared with patients without K pneumoniae colonization at admission. The incidence of subsequent CRKP infection in the baseline CSKP (32.3%, 10 of 31) and CRKP (45.9%, 17 of 37) carrier group was significantly higher than that of the baseline non-KP carrier group (8.6%, 15 of 175). The risk factors associated with acquired CRKP colonization during the ICU stay among negative CRKP colonization at admission included previous exposure to carbapenem, tigecycline or β-lactam/β-lactamases inhibitor, and invasive processes or surgical operations. Sixty-four percent (27 of 42) of patients with K pneumoniae infection were colonized by clonally related K pneumoniae strains according to enterobacterial repetitive intergenic consensus sequence-polymerase chain reaction analysis. ST11 (72%, 53 of 74) was the most predominant MLST type of clonally related CRKP isolate colonizing these patients, followed by ST15 (26%, 19 of 74). CONCLUSIONS: The colonization of K pneumoniae may increase the incidence of corresponding K pneumoniae infection in critically ill patients in the ICU. High prevalence of ST11 CRKP (due to blaKPC-2) carriage and infection in ICU was observed. SN - 1537-6613 UR - https://www.unboundmedicine.com/medline/citation/32176790/The_Colonization_of_Carbapenem_Resistant_Klebsiella_pneumoniae:_Epidemiology_Resistance_Mechanisms_and_Risk_Factors_in_Patients_Admitted_to_Intensive_Care_Units_in_China_ L2 - https://academic.oup.com/jid/article-lookup/doi/10.1093/infdis/jiz622 DB - PRIME DP - Unbound Medicine ER -
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