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Clin Microbiol Infect. 2013 Jan;19(1):E23-E30. doi: 10.1111/1469-0691.12070. Epub 2012 Nov 9.

High rate of colistin resistance among patients with carbapenem-resistant Klebsiella pneumoniae infection accounts for an excess of mortality.

Author information

1
2nd Division of Infectious Diseases, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy. Electronic address: maddalena.giannella@libero.it.
2
2nd Division of Infectious Diseases, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy.
3
Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanitá, Rome, Italy.
4
Department of Microbiology, University "La Sapienza" Policlinico Umberto I, Rome, Italy.
5
Department of Microbiology, Azienda Ospedaliera San Filippo Neri, Rome, Italy.
6
Department of Infectious Diseases, University "La Sapienza" Policlinico Umberto I, Rome, Italy.
7
Department of Microbiology, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy.
8
Department of Microbiology, Azienda Ospedaliera Grassi Ostia, Rome, Italy.
9
Department of Microbiology, Santa Lucia Fundation, Rome, Italy.
10
Health-care Infectious Unit, Azienda Ospedaliera San Giovanni Addolorata.
11
Microbiology and Heart Surgery ICU, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy.

Abstract

Carbapenem-resistant Klebsiella pneumoniae (CR-KP) is becoming a common cause of healthcare-associated infection in Italy, with high morbidity and mortality. Prevalent CR-KP clones and resistance mechanisms vary between regions and over time. Therapeutic approaches and their impact on mortality have to be investigated. We performed a prospective study of patients with CR-KP isolation, hospitalized in nine hospitals of Rome, Italy, from December 2010 to May 2011, to describe the molecular epidemiology, antibiotic treatment and risk factors for mortality. Overall, 97 patients (60% male, median age 69 years) were enrolled. Strains producing blaKPC-3 were identified in 89 patients, blaVIM in three patients and blaCTX-M-15 plus porin defects in the remaining five patients. Inter-hospital spread of two major clones, ST512 and ST258, was found. Overall, 36.1% and 20.4% of strains were also resistant to colistin and tigecycline, respectively. Infection was diagnosed in 91 patients who received appropriate antibiotic treatment, combination therapy and removal of the infectious source in 73.6%, 59.3% and 28.5% of cases, respectively. Overall, 23 different antibiotic regimens were prescribed. In-hospital mortality was 25.8%. Multivariate analysis adjusted for appropriate treatment, combination therapy and infectious-source removal, showed that Charlson comorbidity score, intensive-care unit onset of infection, bacteraemia and infection due to a colistin-resistant CR-KP strain were independent risk factors for mortality. The spread of clones producing K. pneumoniae carbapenemases, mainly ST258, is currently the major cause of CR-KP infection in central Italy. We observed a high rate of resistance to colistin that is independently associated with worse outcome.

PMID:
23137235
DOI:
10.1111/1469-0691.12070
[Indexed for MEDLINE]
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