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

  • Khetam Hussein (a1), Hanna Sprecher (a2), Tania Mashiach (a1), Ilana Oren (a1) (a3), Imad Kassis (a1) (a3) and Renato Finkelstein (a1) (a3)...
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.

Copyright
Corresponding author
Infectious Diseases Unit, Rarabam Medical Center, 31096-Bat Galim, Haifa (rfinkelstein@rambam.health.gov.il)
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1. H Knothe , P Shah , V Krcméry , M Antal , S Mitsuhashi . Transferable resistance to cefotaxime, cefoxitin, cefamandole, and cefuroxime in clinical isolates of Klebsiella pneumoniae and Serratia marcescens. Infection 1983;11:315317.

2. PL Winokur , R Canton , JM Casellas , N Legakis . 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):S94103.

3. GA Jacoby , LS Munoz-Price . The new /3-lactamases. N Engl J Med 2005;352:380391.

4. N Kassis-Chikhani , D Decré , V Gautier , et al.First outbreak of multidrug-resistant Klebsiella pneumoniae carrying blaVIM-1 and blaSHV-5 in a French university hospital. J Antimicrob Chemother 2006;57:142145.

5. S Cagnacci , L Gualcp , S Roveta , 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;61:296300.

6. M Psichogiou , PT Tassios , A Avlamis , et al.Ongoing epidemic of blaVIM-1, -positive Klebsiella pneumoniae in Athens, Greece: a prospective survey. Antimicrob Chemother 2008;61:5963.

7. M Tato , TM Coque , P Ruîz-Garbajosa , 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;45:11711178.

8. DL Paterson . Resistance in gram-negative bacteria: Enterobacteriaceae. Am J Med 2006;119(Suppl 1):S20S28.

9. S Bratu , D Landman , R Haag , 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.

10. T Chiang , N Mariano , C Urban , et al.Identification of carbapenem-resistant Klebsiella pneumoniae harboring KPC enzymes in New Jersey. Microb Drug Resist 2007;13:235240.

11. Z Samra , O Ofir , Y Lichtzinsky , L Madar-Shapito , J Bishara . Outbreak of carbapenem-resistant Klebsiella pneumoniae producing KPC-3 in a tertiary medical centre in Israel. Int J Antimicrob Agents 2007;30:525529.

12. A Leavitt , S Navon-Venezia , I Chmelnitsky , MJ Schwaber , Y Carmeli . Emergence of KPC-2 and KPC-3 in carbapenem-resistant Klebsiella pneumoniae strains in an Israeli hospital. Antimicrob Agents Chemother 2007;51:30263029.

13. ME Charlson , P Pompei , KL Ales , R MacKenzie . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373383.

15. T Kotlovsky , L Austin , R Shalginov , H Sprecher . Rapid detection of blaKPC-positive Klebsiella pneumoniae in a clinical setting. Eur J Clin Microbio Infect Dis 2009;28:309311.

16. M Anthony , B Rose , MB Pegler , M Elkins , et al.Genetic analysis of Pseudomonas aeruginosa isolates from the sputa of Australian adult cystic fibrosis patients. J Clin Microbiol 2002;40:27722778.

19. GW Sun , TL Shook , GL Kay . Inappropriate use of bivariate analysis to screen risk factors for use in multivariable analysis. J Clin Epidemiol 1996;49:907916.

21. ME Falagas , PI Rafailidis , D Kofteridis , et al.Risk factors of carbapenem-resistant Klebsiella pneumonia infections: a matched case-control study. J Antimicrob Chemother 2007;60:11241130.

22. MJ Schwaber , S Klarfeld-Lidji , S Navon-Venezia , D Schwartz , A Leavitt , Y Carmeli . Predictors of carbapenem-resistant Klebsiella pneumonia acquisition among hospitalized adults, and effect of acquisition on mortality. Antimicrob Agents Chemother 2008;52:10281033.

23. DL Paterson . The epidemiological profile of infections with multidrug-resistant Pseudomonas aeruginosa and Acinetobacter species. Clin Infect Dis 2006;43:S43-S48.

24. LJV Piddock . Mechanisms of resistance to fluoroquinolones: state-of-the-art 1992-1994. Drugs 1995;49(Suppl 2):2935.

25. E Smith Moland , ND Hanson , LV Herrera , et al.Plasmid-mediated, carbapenem-hydrolysing β-lactamase, KPC-2, in Klebsiella pneumoniae isolates. J Antimicrob Chemother 2003;51:711714.

26. N Woodford , PM Tierno Jr, K Young , 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;48:47934799.

27. YG Kwak , SH Choi , EJ Choo , et al.Risk factors for the acquisition of carbapenem-resistant K. pneumoniae among hospitalized patients. Mi-crob Drug Resist 2005;11:165169.

29. ES Moland , JA Black , J Ourada , MD Reisbig , ND Hanson , KS Thomson . Occurrence of newer β-lactamases in Klebsiella pneumoniae isolates from 24 US hospitals. Antimicrob Agents Chemother 2002;46:38373842.

30. V Miriagou , LS Tzouvelekis , S Rossiter , E Tzelepi , FJ Angulo , JM Whichard . Imipenem resistance in a Salmonella clinical strain due to plasmid-mediated class A carbapenemase KPC-2. Antimicrob Agents Chemother 2003;47:12971300.

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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