Influence of antibiotic pressure on multi-drug resistant Klebsiella pneumoniae colonisation in critically ill patients

Abstract

Background The aim of this study is to evaluate the risk factors for colonisation by multidrug resistant (MDR) K. pneumoniae in a critical care unit and the relationship between colonisation and the antibiotic pressure exerted by the antimicrobial treatments received by patients. Methods A prospective observational was designed. Patients admitted for more than 48 h to an intensive care unit were included. Samples for surveillance cultures were obtained from all the patients upon admission and once a week. The association between risk factors and colonisation by MDR K. pneumoniae was determined by logistic regression. A Cox regression model was used to evaluate the effect of the use of antimicrobials on the colonisation rate. An ARMIA model was used to investigate the association between the incidence of colonisation by MDR strains and the global consumption of antimicrobials in the unit. Results One thousand seven hundred twenty-five patients were included, from which 308 (17.9%) were positive for MDR K. pneumoniae . In the multivariate analysis, hospitalisation for longer than 7 days together with respiratory infection and administration of any antibiotic was associated with increased MR K. pneumoniae colonisation. Patients who received antibiotics for more than 48 h were colonised earlier than patients who did not receive antibiotic treatment [HR: 2.16 (95%CI:1.55–3.03)]. The ARIMA model found a significant association between the monthly colonisation rate for MR K. pneumoniae and the consumption of cephalosporins and carbapenems in the previous month. Conclusion Individual antibiotic administration and the global antibiotic pressure of cephalosporins and carbapenems are associated to an increased colonisation by MDR K. pneumoniae strains.

Characterization of Carbapenem-Resistant Klebsiella pneumoniae ST15 Clone Coproducing KPC-2, CTX-M-15 and SHV-28 Spread in an Intensive Care Unit of a Tertiary Hospital

“…Most of the patients with CRKP infection in this study had an advanced age, long hospital stays, a history of antibiotic treatment and invasive operations or treatments during hospitalization, which have been confirmed as important risk factors for CRKP colonization. 29 , 30 It was reported that CRKP colonization can increase the risk of subsequent infection. 31 Also, the relatively weak immune function of ICU patients may enhance the invasive ability of pathogens, which can be seen in three patients with bloodstream infection.…”

A genomic epidemiology study of multidrug-resistant Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumannii in two intensive care units in Hanoi, Vietnam

“…Colonisation was found to be a large reservoir for AMR, with the majority of E. coli and more than half of the K. pneumoniae isolated from stool samples, as has been documented previously in Vietnamese hospitals (57) . High community usage of antibiotics in Vietnam is likely to promote colonisation with AMR bacteria, as prior treatment with antibiotics is known to lead to colonisation (58) . Colonisation itself has been identified as a risk factor for subsequent infection (59-61) , and has been previously documented in ICU patients in southern Vietnam (62) .…”

The Glucosinolates: A Sulphur Glucoside Family of Mustard Anti-Tumour and Antimicrobial Phytochemicals of Potential Therapeutic Application

“…By removing the normal bacterial microflora, antibiotics actually provide an opportunistic niche for the emergence of antibiotic-resistant bacterial strains which no longer have to compete with the normal bacterial populations present in the body [71,72]. Klebsiella pneumoniae is a Gram negative, facultative anaerobic commensal microorganism that can cause chronic urinary tract and soft tissue infections, pneumonia, and sepsis, and mostly occurs in immunocompromised patients [73]. Klebsiella pneumoniae normally colonises the mouth, skin, and intestines.…”