Skip to main content Accessibility help
×
Home

Bloodstream Infections Caused by Metallo-β-Lactamase/Klebsiella pneumoniae Carbapenemase–Producing K. pneumoniae among Intensive Care Unit Patients in Greece: Risk Factors for Infection and Impact of Type of Resistance on Outcomes

  • Eleni Mouloudi (a1), Euthymia Protonotariou (a2), Alexia Zagorianou (a2), Elias Iosifidis (a3), Areti Karapanagiotou (a1), Tatiana Giasnetsova (a1), Agoritsa Tsioka (a1), Emmanuel Roilides (a3), Danai Sofianou (a2) and Nikoleta Gritsi-Gerogianni (a1)...

Abstract

Objective.

To determine risk factors for bloodstream infections (BSIs) caused by Klebsiella pneumoniae producing metallo-β-lactamases (MBLs) or K. pneumoniae carbapenemases (KPCs), as well as risk factors for mortality associated with carbapenem-resistant K. pneumoniae, among intensive care unit (ICU) patients.

Methods.

Two case-control studies were conducted in a patient cohort with K. pneumoniae BSIs in an 8-bed ICU in a Greek hospital from January 1, 2007, through December 31, 2008. In study 1, patients with K. pneumoniae BSIs were allocated among 3 groups according to isolate susceptibility profile: (1) carbapenem-susceptible insolates (control group), (2) MBL-producing isolates, or (3) KPC-producing isolates. The MBL and KPC groups were compared with the control group to identify risk factors for development of K. pneumoniae BSI. In study 2, patients with K. pneumoniae BSIs who died were compared with survivors to identify risk factors for mortality.

Results.

Fifty-nine patients had K. pneumoniae BSIs (22 with carbapenem-susceptible isolates, 18 with MBL-producing isolates, and 19 with KPC-producing isolates). All KPC-producing isolates carried the blaKPC-2 gene, and 17 of 18 MBL-producing isolates carried blaVIM-1 Acute Physiology and Chronic Health Evaluation II score (odds ratio, 1.13 [95% confidence interval, 1.03–1.25]; P = .02) was independently associated with KPC-producing K. pneumoniae BSIs. Nine (41%) of 22 control patients, 8 (44%) of 18 MBL group patients, and 13 (68%) of 19 KPC group patients died in the ICU. Nine (41%) of 22 control patients, 10 (56%) of 18 MBL group patients, and 15 (79%) of 19 KPC group patients died in the hospital. Isolation of KPC-producing K. pneumoniae was an independent predictor of ICU death (P = .04) and in-hospital death (P = .03) but not infection-attributable death.

Conclusions.

BSIs due to KPC-producing K. pneumoniae resulted in significantly increased mortality. The accurate and rapid detection of these pathogens is necessary for therapeutic considerations and for the implementation of infection control measures to contain them.

Copyright

Corresponding author

Third Department of Pediatrics, Aristotle University, Hippokration Hospital, Konstantinoupoleos 49, GR-54642, Thessaloniki, Greece, (roilides@med.auth.gr)

References

Hide All
1.Gasink, LB, Edelstein, PH, Lautenbach, E, Synnestvedt, M, Fishman, NO. Risk factors and clinical impact of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae. Infect Control Hosp Epidemiol 2009;30:11801185.
2.Pournaras, S, Iosifidis, E, Roilides, E. Advances in antibacterial therapy against emerging bacterial pathogens. Semin Hematol 2009;46:198211.
3.Cagatay, AA, Ozean, PE, Gulec, L, et al.Risk factors for mortality of nosocomial bacteraemia in intensive care units. Med PrincPract 2007; 16: 187192.
4.Pitout, JD, Laupland, KB. Extended-spectrum β-lactamase-producing Enterobacteriaceae: an emerging public-health concern. Lancet Infect Dis 2008;8:159166.
5.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;165:14301435.
6.Souli, M, Galani, I, Antoniadou, A, et al.An outbreak of infection due to β-lactamase Klebsiella pneumoniae carbapenemase 2-producing K. pneumoniae in a Greek university hospital: molecular characterization, epidemiology, and outcomes. Clin Infect Dis 2010;50:364373.
7.Marchaim, D, Navon-Venezia, S, Schwaber, MJ, Carmeli, Y. Isolation of imipenem-resistant Enterobacter species: emergence of KPC-2 carbapenemase, molecular characterization, epidemiology, and outcomes. Antimicrob Agents Chemother 2008;52:14131418.
8.Hall, BG, Barlow, M. Revised Ambler classification of β-lactamases. J Antimicrob Chemother 2005;55:10501051.
9.Queenan, AM, Bush, K. Carbapenemases: the versatile β-lactamases. Clin Microbiol Rev 2007;20:440458.
10.Patel, G, Huprikar, S, Factor, SH, lenkins, SG, Calfee, DP. Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol 2008;29:10991106.
11.Schwaber, MJ, Klarfeld-Lidji, S, Navon-Venezia, S, Schwartz, D, Leavitt, A, Carmeli, Y. Predictors of carbapenem-resistant Klebsiella pneumoniae acquisition among hospitalized adults and effect of acquisition on mortality. Antimicrob Agents Chemother 2008;52:10281033.
12.Falagas, ME, Rafailidis, PI, Kofteridis, D, et al.Risk factors of carbapenem-resistant Klebsiella pneumoniae infections: a matched case control study. J Antimicrob Chemother 2007;60:11241130.
13.Hussein, K, Sprecher, H, Mashiach, T, Oren, I, Kassis, I, Finkelstein, R. Carbapenem resistance among Klebsiella pneumoniae isolates: risk factors, molecular characteristics, and susceptibility patterns. Infect Control Hosp Epidemiol 2009;30:666671.
14.Kwak, YG, Choi, SH, Choo, EJ, et al.Risk factors for the acquisition of carbapenem-resistant Klebsiella pneumoniae among hospitalized patients. Microb Drug Resist 2005;11:165169.
15.Daikos, GL, Petrikkos, P, Psichogiou, M, et al.Prospective observational study of the impact of VIM-1 metallo-β-lactamase on the outcome of patients with Klebsiella pneumoniae bloodstream infections. Antimicrob Agents Chemother 2009;53:18681873.
16.Knaus, WA, Draper, EA, Wagner, DP, Zimmerman, JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818829.
17.Vincent, JL, Moreno, R, Takala, I, et al.The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. Intensive Care Med 1996;22:707710.
18.Clinical and Laboratory Standard Institute (CLSI). Performance standards for antimicrobial susceptibility testing: 17th informational supplement. Wayne, PA: CLSI; 2007. CLSI document M100-S117.
19.European Committee on Antimicrobial Susceptibility Testing website. http://www.eucast.org/. Accessed May 17, 2010.
20.Vitti, D, Protonotariou, E, Sofianou, D. Carbapenem-resistant Escherichia coli carrying the bla VIM-1 gene in the community. Int J Antimicrob Agents 2009;34:187188.
21.Tokatlidou, D, Tsivitanidou, M, Pournaras, S, Ikonomidis, A, Tsakris, A, Sofianou, D. Outbreak caused by a multidrug-resistant Klebsiella pneumoniae clone carrying bla VIM-12 in a university hospital. J Clin Microbiol 2008;46:10051008.
22.National Center for Biotechnology Information website. http://www.ncbi.nlm.nih.gov/. Accessed May 17, 2010.
23. ClustalW2. European Bioinformatics Institute, European Molecular Biology Laboratory, website. http://www.ebi.ac.uk/Tools/clustalw2/index.html. Accessed May 17, 2010.
24.Fournier, PE, Richet, H. The epidemiology and control of Adnetobacter baumannii in health care facilities. Clin Infect Dis 2006;42:692699.
25.Falagas, ME, Kopterides, P, Siempos, II. Attributable mortality of Acinetobacter baumannii infection among critically ill patients [letter]. Clin Infect Dis 2006;43:389; reply 389-390.
26.Giske, CG, Monnet, DL, Cars, O, Carmeli, Y. Clinical and economic impact of common multidrug-resistant gram-negative bacilli. Antimicrob Agents Chemother 2008;52:813821.
27.Falagas, ME, Kasiakou, SK. Colistin: the revival of polymyxins for the management of multidrug-resistant gram-negative bacterial infections. Clin Infect Dis 2005;40:13331341.
28.Souli, M, Kontopidou, FV, Papadomichelakis, E, Galani, I, Armaganidis, A, Giamarellou, H. Clinical experience of serious infections caused by Enterobacteriaceae producing VIM-1 metallo-β-lactamase in a Greek university hospital. Clin Infect Dis 2008;46:847854.
29.Falagas, ME, Kopterides, P. Risk factors for the isolation of multi-drug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa: a systematic review of the literature. J Hosp Infect 2006;64:715.

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed