Hostname: page-component-6766d58669-l4t7p Total loading time: 0 Render date: 2026-05-18T07:31:27.471Z Has data issue: false hasContentIssue false
  • English
  • Français

Carbapenem Resistance Among Klebsiella pneumoniae Isolates Risk Factors, Molecular Characteristics, and Susceptibility Patterns

Published online by Cambridge University Press:  02 January 2015

Khetam Hussein ,
Hanna Sprecher ,
Tania Mashiach ,
Ilana Oren ,
Imad Kassis  and
Renato Finkelstein
Khetam Hussein
Affiliation:
Infectious Diseases Unit, Haifa, Israel
Hanna Sprecher
Affiliation:
Clinical Microbiology Department, Haifa, Israel
Tania Mashiach
Affiliation:
Infectious Diseases Unit, Haifa, Israel
Ilana Oren
Affiliation:
Infectious Diseases Unit, Haifa, Israel Rambam Medical Center, and the Bruce Rapport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
Imad Kassis
Affiliation:
Infectious Diseases Unit, Haifa, Israel Rambam Medical Center, and the Bruce Rapport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
Renato Finkelstein*
Affiliation:
Infectious Diseases Unit, Haifa, Israel Rambam Medical Center, and the Bruce Rapport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
*
Infectious Diseases Unit, Rarabam Medical Center, 31096-Bat Galim, Haifa (rfinkelstein@rambam.health.gov.il)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

Carbapenem resistance among isolates of Klebsiella pneumoniae has been unusual.

Objectives.

To identify risk factors for infection with carbapenem-resistant K. pneumoniae (CRKP) and to characterize microbiological aspects of isolates associated with these infections.

Design.

Retrospective case-control study.

Setting.

A 900-bed tertiary care hospital.

Results.

From January 2006 through April 2007, K. pneumoniae was isolated from 461 inpatients; 88 had CRKP infection (case patients), whereas 373 had carbapenem-susceptible K. pneumoniae infection (control subjects). The independent risk factors for infection with CRKP were prior fluoroquinolone use (odds ratio [OR], 1.87 [95% confidence interval {CI}, 1.07–3.26]; P = .026), previous receipt of a carbapenem drug (OR, 1.83 [95% CI, 1.02–3.27]; P = .042), admission to the intensive care unit (OR, 4.27 [95% CI, 2.49–7.31]; P < .001), and exposure to at least 1 antibiotic drug before isolation of K. pneumoniae (OR, 3.93 [95% CI, 1.15–13.47]; P = .029). All CRKP isolates carried the blaKPC gene. Approximately 90% of the tested isolates carried the blaKPC-2 allele, suggesting patient-to-patient transmission. Almost all CRKP isolates were resistant to all antibiotics, except to Colistin (resistance rate, 4.5%), gentamicin (resistance rate, 7%), and tigecycline (resistance rate, 15%).

Conclusions.

CRKP should be regarded as an emerging clinical threat. Because these isolates are resistant to virtually all commonly used antibiotics, control of their spread is crucial.

Information

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 7 , July 2009 , pp. 666 - 671
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1.Knothe, H, Shah, P, Krcméry, V, Antal, M, Mitsuhashi, S. Transferable resistance to cefotaxime, cefoxitin, cefamandole, and cefuroxime in clinical isolates of Klebsiella pneumoniae and Serratia marcescens. Infection 1983;11:315–317.CrossRefGoogle ScholarPubMed
2.Winokur, PL, Canton, R, Casellas, JM, Legakis, N. Variations in the prevalence of strains expressing an extended-spectrum β-lactamase pheno-type and characterization of isolates from Europe, the Americas, and the Western Pacific region. Clin Infect Dis 2001;32(Suppl 2):S94–103.CrossRefGoogle Scholar
3.Jacoby, GA, Munoz-Price, LS. The new /3-lactamases. N Engl J Med 2005;352:380–391.CrossRefGoogle Scholar
4.Kassis-Chikhani, N, Decré, D, Gautier, V, et al.First outbreak of multidrug-resistant Klebsiella pneumoniae carrying bla VIM-1 and bla SHV-5 in a French university hospital. J Antimicrob Chemother 2006;57:142–145.CrossRefGoogle Scholar
5.Cagnacci, S, Gualcp, L, Roveta, S, et al.Bloodstream infections caused by multidrug-resistant Klebsiella pneumoniae producing the carbapenem-hydrolysing VIM-1 metallo-β-lactamase: first Italian outbreak. J Antimicrob Chemother 2008;61:296–300.CrossRefGoogle ScholarPubMed
6.Psichogiou, M, Tassios, PT, Avlamis, A, et al.Ongoing epidemic of bla VIM-1, -positive Klebsiella pneumoniae in Athens, Greece: a prospective survey. Antimicrob Chemother 2008;61:59–63.CrossRefGoogle ScholarPubMed
7.Tato, M, Coque, TM, Ruîz-Garbajosa, P, et al.Complex clonal and plasmid epidemiology in the first outbreak of Enterobacteriaceae infection involving VIM-1 metallo-β-lactamase in Spain: toward endemicity? Clin Infect Dis 2007;45:1171–1178.CrossRefGoogle ScholarPubMed
8.Paterson, DL. Resistance in gram-negative bacteria: Enterobacteriaceae. Am J Med 2006;119(Suppl 1):S20–S28.CrossRefGoogle ScholarPubMed
9.Bratu, S, Landman, D, Haag, R, et al.Rapid spread of carbapenem-resistant Klebsiella pneumoniae in New York City: a new threat to our antibiotic armamentarium. Arch Intern Med 2005;165:1430–1435.CrossRefGoogle ScholarPubMed
10.Chiang, T, Mariano, N, Urban, C, et al.Identification of carbapenem-resistant Klebsiella pneumoniae harboring KPC enzymes in New Jersey. Microb Drug Resist 2007;13:235–240.CrossRefGoogle ScholarPubMed
11.Samra, Z, Ofir, O, Lichtzinsky, Y, Madar-Shapito, L, Bishara, J. Outbreak of carbapenem-resistant Klebsiella pneumoniae producing KPC-3 in a tertiary medical centre in Israel. Int J Antimicrob Agents 2007;30:525–529.CrossRefGoogle Scholar
12.Leavitt, A, Navon-Venezia, S, Chmelnitsky, I, Schwaber, MJ, Carmeli, Y. Emergence of KPC-2 and KPC-3 in carbapenem-resistant Klebsiella pneumoniae strains in an Israeli hospital. Antimicrob Agents Chemother 2007;51:3026–3029.CrossRefGoogle Scholar
13.Charlson, ME, Pompei, P, Ales, KL, MacKenzie, R. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.CrossRefGoogle ScholarPubMed
14.Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing: 16th informational supplement. CLSI document. Wayne, PA: CLSI, 2006:M100-S16.Google Scholar
15.Kotlovsky, T, Austin, L, Shalginov, R, Sprecher, H. Rapid detection of bla KPC-positive Klebsiella pneumoniae in a clinical setting. Eur J Clin Microbio Infect Dis 2009;28:309–311.CrossRefGoogle Scholar
16.Anthony, M, Rose, B, Pegler, MB, Elkins, M, et al.Genetic analysis of Pseudomonas aeruginosa isolates from the sputa of Australian adult cystic fibrosis patients. J Clin Microbiol 2002;40:2772–2778.CrossRefGoogle ScholarPubMed
17.Mantel, N, Haenszel, W. Statistical aspects of analysis of data from retrospective studies of disease. J Natl Cancer Inst 1959;22:719–748.Google ScholarPubMed
18.Hosmer, DO, Lemeshow, SL. Applied logistic regression. New York: Willey and Sons; 1989.Google Scholar
19.Sun, GW, Shook, TL, Kay, GL. Inappropriate use of bivariate analysis to screen risk factors for use in multivariable analysis. J Clin Epidemiol 1996;49:907–916.CrossRefGoogle ScholarPubMed
20.Mickey, RM, Greeland, S. The impact of selection confounder selection criteria on effect estimation. Am J Epidemiol 1989;129:125–137.CrossRefGoogle ScholarPubMed
21.Falagas, ME, Rafailidis, PI, Kofteridis, D, et al.Risk factors of carbapenem-resistant Klebsiella pneumonia infections: a matched case-control study. J Antimicrob Chemother 2007;60:1124–1130.CrossRefGoogle ScholarPubMed
22.Schwaber, MJ, Klarfeld-Lidji, S, Navon-Venezia, S, Schwartz, D, Leavitt, A, Carmeli, Y. Predictors of carbapenem-resistant Klebsiella pneumonia acquisition among hospitalized adults, and effect of acquisition on mortality. Antimicrob Agents Chemother 2008;52:1028–1033.CrossRefGoogle ScholarPubMed
23.Paterson, DL. The epidemiological profile of infections with multidrug-resistant Pseudomonas aeruginosa and Acinetobacter species. Clin Infect Dis 2006;43:S43-S48.CrossRefGoogle ScholarPubMed
24.Piddock, LJV. Mechanisms of resistance to fluoroquinolones: state-of-the-art 1992-1994. Drugs 1995;49(Suppl 2):29–35.CrossRefGoogle ScholarPubMed
25.Smith Moland, E, Hanson, ND, Herrera, LV, et al.Plasmid-mediated, carbapenem-hydrolysing β-lactamase, KPC-2, in Klebsiella pneumoniae isolates. J Antimicrob Chemother 2003;51:711–714.CrossRefGoogle ScholarPubMed
26.Woodford, N, Tierno, PM Jr, Young, K, et al.Outbreak of Klebsiella pneumoniae producing a new carbapenem-hydrolyzing class A β-lacta-mase, KPC-3, in a New York medical center. Antimicrob Agents Chemother 2004;48:4793–4799.CrossRefGoogle Scholar
27.Kwak, YG, Choi, SH, Choo, EJ, et al.Risk factors for the acquisition of carbapenem-resistant K. pneumoniae among hospitalized patients. Mi-crob Drug Resist 2005;11:165–169.CrossRefGoogle ScholarPubMed
28.Patel, G, Huprikar, S, Factor, SH, Jenkins, SG, Calfee, DP. Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol 2008;29:1099–1106.CrossRefGoogle ScholarPubMed
29.Moland, ES, Black, JA, Ourada, J, Reisbig, MD, Hanson, ND, Thomson, KS. Occurrence of newer β-lactamases in Klebsiella pneumoniae isolates from 24 US hospitals. Antimicrob Agents Chemother 2002;46:3837–3842.CrossRefGoogle Scholar
30.Miriagou, V, Tzouvelekis, LS, Rossiter, S, Tzelepi, E, Angulo, FJ, Whichard, JM. Imipenem resistance in a Salmonella clinical strain due to plasmid-mediated class A carbapenemase KPC-2. Antimicrob Agents Chemother 2003;47:1297–1300.CrossRefGoogle Scholar