Konstantina Kontopoulou1, Elias Iosifidis2, Eleni Antoniadou3, Polychronis Tasioudis3, Efthymia Petinaki4, Ergina Malli4, Symeon Metallidis5, Alkiviadis Vatopoulos6, Nicolaos Malisiovas7. 1. 1 Department of Microbiology, G.Gennimatas General Hospital, Thessaloniki, Greece. 2. 2 3rd Department of Pediatrics, Hippokration Hospital, Aristotle University, Thessaloniki, Greece. 3. 3 ICU, G. Gennimatas General Hospital, Thessaloniki, Greece. 4. 4 Department of Microbiology, Medical School, University of Thessaly, Larissa, Greece. 5. 5 1st Internal Medicine Department, Infectious Diseases Division, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Greece. 6. 6 Department of Microbiology, National School of Public Health, Greece. 7. 7 Department of Microbiology, Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece.
Abstract
PURPOSE: To highlight the clinical significance of carbapenem-resistant Klebsiella pneumoniae (CRKP) rectal colonization by examining the risk factors for CRKP rectal colonization and subsequent bloodstream infection (BSI) in critically ill patients. METHODOLOGY: Prospective study of CRKP rectal colonization in an intensive care unit (ICU) during a 39-month period. CRKP strains isolated from both the blood cultures and corresponding rectal specimens (n=96) of patients were screened by PCR for the presence of antibiotic resistance-associated genes. Molecular analyses were conducted to investigate the clonal relatedness of CRKP strains from the rectal and blood specimens. RESULTS: Among the 498 patients, 226 were rectally colonized by CRKP, 48 of whom developed a CRKP BSI. The median time from hospital admission to the detection of CRKP rectal colonization was 8 days, while the median time from colonization to BSI was 4 days. The duration of ICU stay, patient/nurse ratio and prior use of antianaerobic antimicrobials were associated with CRKP rectal colonization. No specific factor was associated with BSIs in the colonized patients. The blaKPC-2 gene was detected in all 96 strains, which were all classified as sequence type ST-258. Representative pairs (n=48) of CRKP strains colonizing and infecting the same patient shared the same pulsotype. CONCLUSION: Our results indicate that hospitalized patients become infected with their colonizing strains, supporting the strong association between colonization and BSI. Limiting antianaerobic antimicrobial administration, reducing the duration of ICU stay and maintaining a low patient/nurse ratio are possible strategies to restrict rectal CRKP colonization in ICUs.
PURPOSE: To highlight the clinical significance of carbapenem-resistant Klebsiella pneumoniae (CRKP) rectal colonization by examining the risk factors for CRKP rectal colonization and subsequent bloodstream infection (BSI) in critically illpatients. METHODOLOGY: Prospective study of CRKP rectal colonization in an intensive care unit (ICU) during a 39-month period. CRKP strains isolated from both the blood cultures and corresponding rectal specimens (n=96) of patients were screened by PCR for the presence of antibiotic resistance-associated genes. Molecular analyses were conducted to investigate the clonal relatedness of CRKP strains from the rectal and blood specimens. RESULTS: Among the 498 patients, 226 were rectally colonized by CRKP, 48 of whom developed a CRKP BSI. The median time from hospital admission to the detection of CRKP rectal colonization was 8 days, while the median time from colonization to BSI was 4 days. The duration of ICU stay, patient/nurse ratio and prior use of antianaerobic antimicrobials were associated with CRKP rectal colonization. No specific factor was associated with BSIs in the colonized patients. The blaKPC-2 gene was detected in all 96 strains, which were all classified as sequence type ST-258. Representative pairs (n=48) of CRKP strains colonizing and infecting the same patient shared the same pulsotype. CONCLUSION: Our results indicate that hospitalized patients become infected with their colonizing strains, supporting the strong association between colonization and BSI. Limiting antianaerobic antimicrobial administration, reducing the duration of ICU stay and maintaining a low patient/nurse ratio are possible strategies to restrict rectal CRKP colonization in ICUs.
Authors: Alexandra Vasilakopoulou; Polyxeni Karakosta; Sophia Vourli; Aikaterini Tarpatzi; Paraskevi Varda; Maria Kostoula; Anastasia Antoniadou; Spyros Pournaras Journal: Front Public Health Date: 2020-03-18
Authors: Giuseppe Migliara; Valentina Baccolini; Claudia Isonne; Sara Cianfanelli; Carolina Di Paolo; Annamaria Mele; Lorenza Lia; Angelo Nardi; Carla Salerno; Susanna Caminada; Vittoria Cammalleri; Francesco Alessandri; Guglielmo Tellan; Giancarlo Ceccarelli; Mario Venditti; Francesco Pugliese; Carolina Marzuillo; Corrado De Vito; Maria De Giusti; Paolo Villari Journal: Antibiotics (Basel) Date: 2021-03-15