Risk factors and outcomes of carbapenem-resistant Klebsiella pneumoniae infections

Abstract

In the nosocomial setting, antimicrobial-resistant Enterobacteriaceae are a growing challenge, and alarming trends in resistance are currently reported all over the world. Isolates of Enterobacteriaceae producing ampC β-lactamases and extended spectrum β-lactamases are endemic in many hospitals, and are frequently resistant also to other classes of antibiotics, such as fluoroquinolones and aminoglycosides. The risk of infections due to multi-drug resistant strains should be considered also for outpatients who have had recent contact with the health system. Both nosocomial and health-care associated infections should be treated with a combination of antibiotics active against multi-drug resistant Gram negative and methicillin-resistant Staphylococcus aureus. In the absence of effective antimicrobial stewardship programs, this aggressive therapeutic approach might lead to abuse of broad-spectrum antibiotics, with consequent increase in resistances. To contain the possible antibiotic overuse, several decisional strategies, often based on risk-score systems supporting the clinical decisions, have been proposed. In this context of high antibiotic selection pressure, carbapenem-resistant pathogens recently began to spread in many hospitals. Carbapenem-resistant Klebsiella pneumoniae, as well as carbapenem-resistant Acinetobacter baumannii and P. aeruginosa, represent the new major challenges to patient safety. Against these organisms the initial empiric treatment is generally ineffective. The poor clinical outcome associated with carbapenem- resistant K. pneumoniae infections is probably due to the delete in the beginning of an appropriate antibiotic treatment, rather than to the increased virulence of pathogens. Only few therapeutic options are available, including colistin, tigecycline, aminoglycosides and carbapenems in selected cases. Several combinations of these antibiotics have been used, but no ideal regimen has been currently established.

High Prevalence of Multidrug-Resistant Klebsiella pneumoniae in a Tertiary Care Hospital in Ethiopia

“…Third-generation cephalosporins have been the treatment of choice for Gram-negative bacteria, including K. pneumoniae, but nowadays, they are largely ineffective due to the emergence of ESBL-producing bacteria [ 8 ]. This was also true in our study, in which one of the high antimicrobial resistance was against 3rd and 4th generation cephalosporins, ceftriaxone (97%), cefotaxime (97%), cefepime (84.1%), and ceftazidime (65.9%).…”

“…It has gained attention worldwide, especially in developed countries, due to its high drug resistance. Antimicrobial resistance rates in K. pneumoniae have steadily increased over the years, and K. pneumoniae is becoming resistant to virtually all aminoglycosides, quinolones, and β-lactams [ 8 ]. For instance, at the European level, more than one-third (36.6%) of K. pneumoniae isolates reported to the European antimicrobial resistance surveillance network for 2019 were resistant to at least one of the antimicrobial groups under regular surveillance, i.e., fluoroquinolones, third-generation cephalosporins, aminoglycosides, and carbapenems [ 9 ].…”

Prior Antibiotic Therapy and the Onset of Healthcare-Associated Infections Sustained by Multidrug-Resistant Klebsiella pneumoniae in Intensive Care Unit Patients: A Nested Case–Control Study

“…The expansion of multidrug-resistant bacteria is one of the main concerns for critically ill patients [ 21 ], and selecting an appropriate antibiotic regimen is essential to preventing the onset of multidrug-resistant infections [ 22 ]. In this study, we found that previous exposure to aminoglycosides, linezolid, penicillins, and colistin increases the likelihood of developing an infection sustained by MDR-Kp among ICU patients, contributing to strengthening the existing literature in this field, which is often inconsistent [ 15 ].…”