期刊
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
卷 58, 期 7, 页码 4035-4041出版社
AMER SOC MICROBIOLOGY
DOI: 10.1128/AAC.02636-14
关键词
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资金
- National Institute of Allergy and Infectious Diseases of the National Institutes of Health [UM1AI104681]
- Clinical and Translational Science Collaborative of Cleveland
- National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health [UL1TR000439]
- NIH Roadmap for Medical Research
- Veterans Affairs Merit Review Program
- National Institutes of Health [AI072219-05, AI063517-07]
- Geriatric Research Education and Clinical Center [VISN 10]
- Research Program Committees of the Cleveland Clinic
- STERIS Corporation
- NHGRI
- NIH Director's Challenge Fund
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.
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