Liyan Cui1, Ning Shen2,3,4, Ping Yang2,3, Chao Liu4, Zhenchao Wu3, Jiajia Zheng1, Juan Yi2, Nan Wu3, Zhangli Wu2,3, Ming Lu3,4. 1. Department of Laboratory Medicine, Peking University Third Hospital, Beijing, People's Republic of China. 2. Institute of Medical Technology, Peking University Health Science Center, Beijing, People's Republic of China. 3. Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, People's Republic of China. 4. Department of Infectious Diseases, Peking University Third Hospital, Beijing, People's Republic of China.
Abstract
Purpose: This study aimed to identify the clinical outcomes, microbiological features and risk factors for difficult-to-treat resistance (DTR) Klebsiella pneumoniae (Kp) infection. Materials and Methods: A retrospective study was conducted at Peking University Third Hospital from January 2020 to March 2021. DTR was defined as resistance to ≥1 carbapenem, ≥1 extended-spectrum cephalosporin, and ≥1 fluoroquinolone. Hypervirulent Kp (HvKp) was defined as peg-344-, iroB-, iucA-, rmpA-, or rmpA2-positive. Clinical data were collected. Antimicrobial susceptibility testing and string tests were performed to determine resistance and hypermucoviscosity phenotype. Whole genome sequencing was performed to analyze the sequence type (ST), capsular serotypes, resistance and virulence genes. Risk factors for 30-day mortality were analyzed. Results: Fifty DTR-Kp (50.0%) strains were identified among 100 patients. Compared to non-DTR-Kp group, a significant number of patients with DTR-Kp infection experienced ICU admission (44.0% versus 10.0%, P<0.001) and mechanical ventilation after Kp detection (26.0% versus 10.0%, P=0.037). Notably, the percentage of hvKp among the DTR-Kp isolates increased consistently over the 15 months evaluated. Most DTR-Kp strains belonged to ST11 (82.0%), followed by ST15 (12.0%), ST86 (2.0%), ST996 (2.0%), and ST3157 (2.0%). DTR-Kp isolates possessed various resistance genes, such as blaKPC-2, blaTEM-1D and fosA3 (90.0%, 80.0% and 72.0%, respectively). Importantly, the yersiniabactin genes were significantly clustered in DTR group (48/50, 96.0%). The 30-day mortality was significantly higher in patients with DTR-Kp infection than non-DTR-Kp group (38.0% versus 8.2%, P=0.001). DTR-Kp infection (odds ratio [OR] = 4.196) was an independent risk factor for the 30-day mortality of Kp-infected patients. Additionally, cerebrovascular disease (OR = 2.780) and Charlson comorbidity index (OR= 1.584) were independent risk factors for DTR-Kp infections. Conclusion: DTR-hvKp is rapidly emerging. The DTR-Kp strains harbored various resistance genes and high rates of yersiniabactin siderophore genes. DTR-Kp infection was an independent risk factor for mortality, suggesting that enhanced awareness essential.
Purpose: This study aimed to identify the clinical outcomes, microbiological features and risk factors for difficult-to-treat resistance (DTR) Klebsiella pneumoniae (Kp) infection. Materials and Methods: A retrospective study was conducted at Peking University Third Hospital from January 2020 to March 2021. DTR was defined as resistance to ≥1 carbapenem, ≥1 extended-spectrum cephalosporin, and ≥1 fluoroquinolone. Hypervirulent Kp (HvKp) was defined as peg-344-, iroB-, iucA-, rmpA-, or rmpA2-positive. Clinical data were collected. Antimicrobial susceptibility testing and string tests were performed to determine resistance and hypermucoviscosity phenotype. Whole genome sequencing was performed to analyze the sequence type (ST), capsular serotypes, resistance and virulence genes. Risk factors for 30-day mortality were analyzed. Results: Fifty DTR-Kp (50.0%) strains were identified among 100 patients. Compared to non-DTR-Kp group, a significant number of patients with DTR-Kp infection experienced ICU admission (44.0% versus 10.0%, P<0.001) and mechanical ventilation after Kp detection (26.0% versus 10.0%, P=0.037). Notably, the percentage of hvKp among the DTR-Kp isolates increased consistently over the 15 months evaluated. Most DTR-Kp strains belonged to ST11 (82.0%), followed by ST15 (12.0%), ST86 (2.0%), ST996 (2.0%), and ST3157 (2.0%). DTR-Kp isolates possessed various resistance genes, such as blaKPC-2, blaTEM-1D and fosA3 (90.0%, 80.0% and 72.0%, respectively). Importantly, the yersiniabactin genes were significantly clustered in DTR group (48/50, 96.0%). The 30-day mortality was significantly higher in patients with DTR-Kp infection than non-DTR-Kp group (38.0% versus 8.2%, P=0.001). DTR-Kp infection (odds ratio [OR] = 4.196) was an independent risk factor for the 30-day mortality of Kp-infected patients. Additionally, cerebrovascular disease (OR = 2.780) and Charlson comorbidity index (OR= 1.584) were independent risk factors for DTR-Kp infections. Conclusion: DTR-hvKp is rapidly emerging. The DTR-Kp strains harbored various resistance genes and high rates of yersiniabactin siderophore genes. DTR-Kp infection was an independent risk factor for mortality, suggesting that enhanced awareness essential.
Authors: A-P Magiorakos; A Srinivasan; R B Carey; Y Carmeli; M E Falagas; C G Giske; S Harbarth; J F Hindler; G Kahlmeter; B Olsson-Liljequist; D L Paterson; L B Rice; J Stelling; M J Struelens; A Vatopoulos; J T Weber; D L Monnet Journal: Clin Microbiol Infect Date: 2011-07-27 Impact factor: 8.067
Authors: Thomas A Russo; Ruth Olson; Chi-Tai Fang; Nicole Stoesser; Mark Miller; Ulrike MacDonald; Alan Hutson; Jason H Barker; Ricardo M La Hoz; James R Johnson Journal: J Clin Microbiol Date: 2018-08-27 Impact factor: 5.948
Authors: Alexis Tabah; Despoina Koulenti; Kevin Laupland; Benoit Misset; Jordi Valles; Frederico Bruzzi de Carvalho; José Artur Paiva; Nahit Cakar; Xiaochun Ma; Philippe Eggimann; Massimo Antonelli; Marc J M Bonten; Akos Csomos; Wolfgang A Krueger; Adam Mikstacki; Jeffrey Lipman; Pieter Depuydt; Aurélien Vesin; Maité Garrouste-Orgeas; Jean-Ralph Zahar; Stijn Blot; Jean Carlet; Christian Brun-Buisson; Claude Martin; Jordi Rello; Georges Dimopoulos; Jean-François Timsit Journal: Intensive Care Med Date: 2012-09-26 Impact factor: 17.440
Authors: Ping Yang; Zhenchao Wu; Chao Liu; Jiajia Zheng; Nan Wu; Zhangli Wu; Juan Yi; Ming Lu; Ning Shen Journal: Front Med (Lausanne) Date: 2022-05-16
Authors: Thomas A Russo; Ruth Olson; Ulrike Macdonald; Daniel Metzger; Lauren M Maltese; Eric J Drake; Andrew M Gulick Journal: Infect Immun Date: 2014-03-24 Impact factor: 3.441