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Antimicrob Agents Chemother. 2014 Jul;58(7):4035-41. doi: 10.1128/AAC.02636-14. Epub 2014 May 5.

Surveillance of carbapenem-resistant Klebsiella pneumoniae: tracking molecular epidemiology and outcomes through a regional network.

Author information

1
Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA david_vanduin@med.unc.edu robert.bonomo@va.gov.
2
Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
3
Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA.
4
Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA.
5
Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA.
6
Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
7
Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA.
8
Department of Microbiology, Cleveland Clinic, Cleveland, Ohio, USA.
9
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA.
10
Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
11
National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA.
12
Department of Biostatistics and Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts, USA.
13
Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA.
14
Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA david_vanduin@med.unc.edu robert.bonomo@va.gov.

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 blaKPC-2 (48%) or blaKPC-3 (51%). One isolate tested positive for blaNDM-1, a sentinel discovery in this region. Important differences between strain types were noted; rep-PCR type B strains were associated with blaKPC-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.

PMID:
24798270
PMCID:
PMC4068524
DOI:
10.1128/AAC.02636-14
[Indexed for MEDLINE]
Free PMC Article

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