Trends in Resistance to Carbapenems and Third-Generation Cephalosporins among Clinical Isolates of Klebsiella pneumoniae in the United States, 1999-2010
Trends in Resistance to Carbapenems and Third-Generation Cephalosporins among Clinical Isolates of Klebsiella pneumoniae in the United States, 1999-2010
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DOI：
10.1086/669523
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发表时间：
2013-03-01
影响因子：
4.5
通讯作者：
Laxminarayan, Ramanan
中科院分区：
文献类型：
--
作者：
Braykov, Nikolay P.;Eber, Michael R.;Laxminarayan, Ramanan
目标。耐多药肠杆菌科构成了严重的感染控制挑战，并已成为公共卫生威胁。我们检查了全国肺炎克雷伯菌对碳青霉烯类（CRKP）和第三代头孢菌素（G3CRKP）耐药比例的趋势。设计和设置。回顾性分析1999年1月至2010年7月在美国287个临床实验室培养的约50万株肺炎克雷伯菌分离株。如果分离株对1种或多种碳青霉烯类不敏感，则定义为CRKP；如果分离株对头孢他啶、头孢曲松或相关抗生素不敏感，则定义为G3CRKP。一项多变量分析检查了耐药分离株比例的趋势，调整了年龄、性别、分离源、患者位置和地理区域。从2002年到2010年，CRKP的粗比重从不到0.1%上升到4.5%；G3CRKP的频率从1999年的5.3%上升到2010年的11.5%。G3CRKP和CRKP在老年患者（大于65岁）中更为常见；相对于儿科患者（18岁以下），G3CRKP的校正优势比（aOR）为1.2(95%可信区间[CI]， 1.2-1.3)， CRKP的校正优势比（aOR）为3.3 （95% CI, 2.6-4.2）。G3CRKP和CRKP在美国东北部患者中（aOR, 2.9 [95% CI, 2.8-3.0]和9.0 [95% CI, 7.9-10.4]）也比在美国西部患者中更常见。门诊CRKP分离株的流行率在2006年后上升，2010年在我们的样本中达到1.9%的分离株（95% CI, 1.6%-2.1%）。G3CRKP和CRKP的频率在美国所有地区都在增加，并且在门诊环境中恢复的分离株中正在出现耐药性。这突出表明需要加强实验室能力和协调监测战略，以遏制这些新出现的病原体的进一步传播。感染控制医院流行病学杂志2013；34 (3): 259 - 268
OBJECTIVE. Multidrug-resistant Enterobacteriaceae pose a serious infection control challenge and have emerged as a public health threat. We examined national trends in the proportion of Klebsiella pneumoniae isolates resistant to carbapenems (CRKP) and third-generation cephalosporins (G3CRKP).DESIGN AND SETTING. Retrospective analysis of approximately 500,000 K. pneumoniae isolates cultured between January 1999 and July 2010 at 287 clinical laboratories throughout the United States.METHODS. Isolates were defined as CRKP if they were nonsusceptible to 1 or more carbapenems and were defined as G3CRKP if they were nonsusceptible to ceftazidime, ceftriaxone, or related antibiotics. A multivariable analysis examined trends in the proportion of resistant isolates, adjusting for age, sex, isolate source, patient location, and geographic region.RESULTS. The crude proportion of CRKP increased from less than 0.1% to 4.5% between 2002 and 2010; the frequency of G3CRKP increased from 5.3% to 11.5% between 1999 and 2010. G3CRKP and CRKP were more common among elderly patients (those greater than 65 years of age); the adjusted odds ratio (aOR) relative to pediatric patients (those less than 18 years of age) was 1.2 for G3CRKP (95% confidence interval [CI], 1.2-1.3) and 3.3 for CRKP (95% CI, 2.6-4.2). G3CRKP and CRKP were also more common among patients from the northeastern United States (aOR, 2.9 [95% CI, 2.8-3.0] and 9.0 [95% CI, 7.9-10.4]) than among those from the western United States. The prevalence of outpatient CRKP isolates increased after 2006, reaching 1.9% of isolates in our sample in 2010 (95% CI, 1.6%-2.1%).CONCLUSIONS. The frequency of G3CRKP and CRKP is increasing in all regions of the United States, and resistance is emerging among isolates recovered in the outpatient setting. This underscores the need for enhanced laboratory capacity and coordinated surveillance strategies to contain the further spread of these emerging pathogens. Infect Control Hosp Epidemiol 2013;34(3):259-268