Evidence of widespread endemic populations of highly multidrug resistant Klebsiella pneumoniae in hospital settings in Hanoi, Vietnam: a prospective cohort study

Pham, My Ha; Hoi, Le Thi; Beale, Mathew A.; Khokhar, Fahad; Hoà, Nguyễn Thị; Musicha, Patrick; Blackwell, Grace A.; Hoang, Long Bao; Hương, Đặng Thị; Binh, Nguyen Gia; Co, Dao Xuan; Giang, Tran Van; Bui, Cuong Van; Tran, Hai Ninh; Bryan, James; Herrick, Archie; Feltwell, Theresa; Nadjm, Behzad; Parkhill, Julian; Doorn, H. Rogier van; Trung, Nguyen Vu; Kính, Nguyễn Văn; Török, M. Estée; Thomson, Nicholas R.

doi:10.1016/s2666-5247(22)00338-x

Cited by 16 publications

(4 citation statements)

References 24 publications

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“…It is worth noting that many studies are conducted in hospital settings, often involving critically ill patients, particularly those in ICUs, or are focused on specific bacterial species. 16 , 17 , 20 Such study settings may introduce selection bias, and prevalence studies should consider sampling diverse populations, settings and regional variations to understand the landscape of CPE. 21 The rise of NDM as a prevalent carbapenemase is indeed alarming.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of screening algorithms to detect rectal colonization with carbapenemase-producing Enterobacterales in a resource-limited setting

Pham,

Nguyen,

et al. 2024

JAC-Antimicrobial Resistance

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Objectives To improve and rationalize the detection of carbapenemase-producing Enterobacterales (CPE) in rectal swabs in a high-prevalence and resource-constrained setting, addressing surveillance challenges typically encountered in laboratories with limited resources. Methods A point prevalence survey (PPS) was conducted on 15 August 2022, in a provincial children’s hospital in northern Vietnam. Rectal swab samples of all admitted children were collected and plated on a selective medium for carbapenem-resistant Enterobacterales (CRE). Species identification and antimicrobial susceptibility testing (AST) were performed by MALDI-TOF, and VITEK2 XL and interpreted according to CLSI breakpoints (2022). Carbapenemases were detected by the carbapenem inactivation method (CIM) and quantitative real-time PCR (qRT-PCR). Results Rectal swab samples were obtained from 376 patients. Of 178 isolates growing on the CRE screening agar, 140 isolates were confirmed as Enterobacterales of which 118 (84.3%) isolates were resistant to meropenem and/or ertapenem. CIM and PCR showed that 90/118 (76.3%) were carbapenemase producers. Overall, 83/367 (22.6%) were colonized by CPE. Klebsiella pneumoniae, Escherichia coli and Enterobacter cloacae complex were the most common CPE detected, with NDM as the predominant carbapenemase (78/90; 86.7%). Phenotypic resistance to meropenem was the best predictor of CPE production (sensitivity 85.6%, specificity 100%) compared with ertapenem resistance (95.6% sensitivity, 36% specificity). CIM was 100% concordant with PCR in detecting carbapenemases. Conclusions These findings underscore the effectiveness of meropenem resistance as a robust indicator of the production of carbapenemases and the reliability of the CIM method to detect such carbapenemases in resource-limited settings where the performance of molecular methods is not possible.

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Section: Discussionmentioning

confidence: 99%

Evaluation of screening algorithms to detect rectal colonization with carbapenemase-producing Enterobacterales in a resource-limited setting

Pham,

Nguyen,

et al. 2024

JAC-Antimicrobial Resistance

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“…This bacterium is also responsible for severe infections in urinary tract, bloodstream infections, and sepsis (2,3). Its signi cance in the clinical settings is highlighted by its propensity for antibiotic resistance, making it a particularly challenging opportunistic pathogen during a patient healthcare period (4,5). Over the past decade, strains of antimicrobial-resistant K. pneumoniae, specially carbapenem-resistant K. pneumoniae (CRKP), have proliferated globally, leading to outbreaks in numerous countries including China (6, 7).…”

Section: Introductionmentioning

confidence: 99%

Advancing Carbapenem-Resistant K. pneumoniae Risk Factor and Prognosis Analysis: A Comparative Study of Machine Learning Techniques Over Traditional Statistical Method

CAI,

Qian,

Xiong

et al. 2024

Preprint

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Background The global rise of carbapenem-resistant Klebsiella pneumoniae (CRKP) poses significant treatment challenges, emphasizing the need to understand contributing factors to infections and their impact on patient prognosis. Traditional models like logistic regression often fall short in handling complex, multidimensional datasets integral to antimicrobial resistance (AMR) research, necessitating advanced analytical approaches. Methods This study compares the efficacy of machine learning techniques—specifically, classification trees and neural networks—against traditional statistical models in analysing risk determinants and prognosis factors of AMR. By integrating demographic, medical records, and next-generation sequencing data, we aimed to leverage machine learning's advanced capabilities to manage complex datasets and provide a comprehensive analysis of factors affecting CRKP infections and patient outcomes. Results Our findings indicate that machine learning techniques, particularly decision trees, offer significant advantages over traditional statistical models in analysing clinical risk factors. The integration of machine learning with next-generation sequencing data enhances the understanding of the genetic basis of AMR, thereby facilitating the development of targeted interventions. Conclusions The application of machine learning techniques represents a preferable alternative for analysing AMR risk determinants and prognosis factors. This study underscores the potential of combining advanced analytical methods with genetic data to improve our understanding and management of AMR, highlighting the critical role of machine learning in advancing research in infectious diseases.

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“…K. pneumoniae is a frequently reported multidrug-resistant (MDR) pathogen isolated from nosocomial settings. Such infections have generally higher mortality rates and require longer treatment regimens and hospital stays, placing a significant burden on healthcare providers [9][10][11]. Of most concern is resistance to β-lactam antibiotics such as penicillin, aztreonam, and extended-spectrum cephalosporins, by horizontally acquired plasmid-mediated β-lactamases [12].…”

Section: Introductionmentioning

confidence: 99%

Transposon mutagenesis screen inKlebsiella pneumoniaeidentifies genetic determinants required for growth in human urine and serum

Gray

Torres

Goodall

et al. 2023

Preprint

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Klebsiella pneumoniae is a global public health concern due to the rising myriad of hypervirulent and multi-drug resistant clones both alarmingly associated with high mortality. The molecular microbial genetics underpinning these recalcitrant K. pneumoniae infections is unclear, coupled with the emergence of lineages resistant to nearly all present day clinically important antimicrobials. In this study, we performed a genome-wide screen in K. pneumoniae ECL8, a member of the endemic K2-ST375 pathotype most often reported in Asia, to define genes essential for growth in a nutrient-rich laboratory medium (Luria-Bertani medium), human urine and serum. Through transposon directed insertion-site sequencing (TraDIS), a total of 427 genes were identified as essential for growth on LB agar, whereas transposon insertions in 11 and 144 genes decreased fitness for growth in either urine or serum, respectively. Genome-wide functional studies like these provide further knowledge on the genetics of this pathogen but also provide a strong impetus for discovering new antimicrobial targets to improve current therapeutic options for K. pneumoniae infections.

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Evidence of widespread endemic populations of highly multidrug resistant Klebsiella pneumoniae in hospital settings in Hanoi, Vietnam: a prospective cohort study

Cited by 16 publications

References 24 publications

Evaluation of screening algorithms to detect rectal colonization with carbapenemase-producing Enterobacterales in a resource-limited setting

Evaluation of screening algorithms to detect rectal colonization with carbapenemase-producing Enterobacterales in a resource-limited setting

Advancing Carbapenem-Resistant K. pneumoniae Risk Factor and Prognosis Analysis: A Comparative Study of Machine Learning Techniques Over Traditional Statistical Method

Transposon mutagenesis screen inKlebsiella pneumoniaeidentifies genetic determinants required for growth in human urine and serum

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