Surveillance of Carbapenem-Resistant Klebsiella pneumoniae: Tracking Molecular Epidemiology and Outcomes through a Regional Network Article (Web of Science)

abstract

  • ABSTRACT Carbapenem resistance in Gram-negative bacteria is on the rise in the United States. A regional network was established to study microbiological and genetic determinants of clinical outcomes in hospitalized patients with carbapenem-resistant (CR) Klebsiella pneumoniae in a prospective, multicenter, observational study. To this end, predefined clinical characteristics and outcomes were recorded and K. pneumoniae isolates were analyzed for strain typing and resistance mechanism determination. In a 14-month period, 251 patients were included. While most of the patients were admitted from long-term care settings, 28% of them were admitted from home. Hospitalizations were prolonged and complicated. Nonsusceptibility to colistin and tigecycline occurred in isolates from 7 and 45% of the patients, respectively. Most of the CR K. pneumoniae isolates belonged to repetitive extragenic palindromic PCR (rep-PCR) types A and B (both sequence type 258) and carried either bla KPC-2 (48%) or bla KPC-3 (51%). One isolate tested positive for bla NDM-1 , a sentinel discovery in this region. Important differences between strain types were noted; rep-PCR type B strains were associated with bla KPC-3 (odds ratio [OR], 294; 95% confidence interval [CI], 58 to 2,552; P < 0.001), gentamicin nonsusceptibility (OR, 24; 95% CI, 8.39 to 79.38; P < 0.001), amikacin susceptibility (OR, 11.0; 95% CI, 3.21 to 42.42; P < 0.001), tigecycline nonsusceptibility (OR, 5.34; 95% CI, 1.30 to 36.41; P = 0.018), a shorter length of stay (OR, 0.98; 95% CI, 0.95 to 1.00; P = 0.043), and admission from a skilled-nursing facility (OR, 3.09; 95% CI, 1.26 to 8.08; P = 0.013). Our analysis shows that (i) CR K. pneumoniae is seen primarily in the elderly long-term care population and that (ii) regional monitoring of CR K. pneumoniae reveals insights into molecular characteristics. This work highlights the crucial role of ongoing surveillance of carbapenem resistance determinants.

authors

  • van Duin, David
  • Perez, Federico
  • Rudin, Susan D.
  • Cober, Eric
  • Ziegler, Julie
  • Webber, Raymond
  • Fox, Jacqueline
  • Mason, Pamela
  • Richter, Sandra S.
  • Cline, Marianne
  • Hall, Geraldine S.
  • Kaye, Keith S.
  • Jacobs, Michael R.
  • Kalayjian, Robert C.
  • Salata, Robert A.
  • Segre, Julia A.
  • Conlan, Sean
  • Evans, Scott
  • Fowler, Vance G.
  • Bonomo, Robert A.

publication date

  • 2014

webpage

published in

number of pages

  • 6

start page

  • 4035

end page

  • 4041

volume

  • 58

issue

  • 7