Spectrum of excess mortality due to carbapenem-resistant Klebsiella pneumoniae infections

352

242

Carbapenem-resistant (CRE) infection is highly endemic in China, but estimates of the infection burden are lacking. We established the incidence of CRE infection from a multicenter study that covered 25 tertiary hospitals in 14 provinces. CRE cases defined as carbapenem-nonsusceptible, ,, or infections during January to December 2015 were collected and reviewed from medical records. Antimicrobial susceptibility testing and carbapenemase gene identification were performed. Among 664 CRE cases, most were caused by (73.9%), followed by (16.6%) and (7.1%). The overall CRE infection incidence per 10,000 discharges was 4.0 and differed significantly by region, with the highest in Jiangsu (14.97) and the lowest in Qinghai (0.34). Underlying comorbidities were found in 83.8% of patients; the median patient age was 62 years (range, 45 to 74 years), and 450 (67.8%) patients were male. Lower respiratory tract infections (65.4%) were the most common, followed by urinary tract infection (16.6%), intra-abdominal infection (7.7%), and bacteremia (7.7%). The overall hospital mortality rate was 33.5%. All isolates showed nonsusceptibility to carbapenems and cephalosporins. The susceptibility rate of polymyxin B was >90%. Tigecycline demonstrated a higher susceptibility rate against than against (90.9% versus 40.2%). Of 155 clinical isolates analyzed, 89% produced carbapenemases, with a majority of isolates producing KPC (50%) or NDM (33.5%)-type beta-lactamases among and The incidence of CRE infection in China was 4.0 per 10,000 discharges. The patient-based disease burden in tertiary hospitals in China is severe, suggesting an urgent need to enhance infection control.

Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Epidemiology of Carbapenem-Resistant Enterobacteriaceae Infections: Report from the China CRE Network

Zhang

Wang

Yin

et al. 2018

352

242

“…Carbapenems are increasingly used for treating severe infections caused by ESBL producers. This is particularly worrisome in a scenario in which carbapenem-resistant Enterobacteriaceae (CRE) are spreading rapidly and are adversely compromising patients' outcomes (7)(8)(9)(10)(11)(12). While recent investigations have suggested that ␤-lactam/␤-lactamase inhibitors (BLBLIs) may be reliable options for the treatment of BSI due to ESBL-producing Gram-negative bacilli (ESBL-GNB), especially in nonimmunocompromised patients (13)(14)(15)(16)(17)(18)(19), other studies have found contrasting data (20,21).…”

mentioning

confidence: 99%

Efficacy of β-Lactam/β-Lactamase Inhibitor Combinations for the Treatment of Bloodstream Infection Due to Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae in Hematological Patients with Neutropenia

Gudiol

Royo-Cebrecos

Abdala

et al. 2017

␤-Lactam/␤-lactamase inhibitors (BLBLIs) were compared to carbapenems in two cohorts of hematological neutropenic patients with extended-spectrum-␤-lactamase (ESBL) bloodstream infection (BSI): the empirical therapy cohort (174 patients) and the definitive therapy cohort (251 patients). The 30-day case fatality rates and other secondary outcomes were similar in the two therapy groups of the two cohorts and also in the propensity-matched cohorts. BLBLIs might be carbapenemsparing alternatives for the treatment of BSI due to ESBLs in these patients.

“…Infections with these pathogens have been associated with substantial mortality and are often difficult to treat (3,4). CPE infections are frequently caused by Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae in the United States and are associated with the spread of K. pneumoniae sequence type 258 (ST258) (5,6).…”

mentioning

confidence: 99%

A Prolonged Outbreak of KPC-3-Producing Enterobacter cloacae and Klebsiella pneumoniae Driven by Multiple Mechanisms of Resistance Transmission at a Large Academic Burn Center

Kanamori

Parobek

Juliano

et al. 2017

Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacter cloacae has been recently recognized in the United States. Whole-genome sequencing (WGS) has become a useful tool for analysis of outbreaks and for determining transmission networks of multidrug-resistant organisms in health care settings, including carbapenem-resistant Enterobacteriaceae (CRE). We experienced a prolonged outbreak of CRE E. cloacae and K. pneumoniae over a 3-year period at a large academic burn center despite rigorous infection control measures. To understand the molecular mechanisms that sustained this outbreak, we investigated the CRE outbreak isolates by using WGS. Twenty-two clinical isolates of CRE, including E. cloacae (n ϭ 15) and K. pneumoniae (n ϭ 7), were sequenced and analyzed genetically. WGS revealed that this outbreak, which seemed epidemiologically unlinked, was in fact genetically linked over a prolonged period. Multiple mechanisms were found to account for the ongoing outbreak of KPC-3-producing E. cloacae and K. pneumoniae. This outbreak was primarily maintained by a clonal expansion of E. cloacae sequence type 114 (ST114) with distribution of multiple resistance determinants. Plasmid and transposon analyses suggested that the majority of bla was transmitted via an identical Tn4401b element on part of a common plasmid. WGS analysis demonstrated complex transmission dynamics within the burn center at levels of the strain and/or plasmid in association with a transposon, highlighting the versatility of KPCproducing Enterobacteriaceae in their ability to utilize multiple modes to resistance gene propagation.