High rate of colistin resistance among patients with carbapenem-resistant Klebsiella pneumoniae infection accounts for an excess of mortality
High rate of colistin resistance among patients with carbapenem-resistant Klebsiella pneumoniae infection accounts for an excess of mortality
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DOI：
10.1111/1469-0691.12070
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发表时间：
2013-01-01
影响因子：
14.2
通讯作者：
Petrosillo, N.
中科院分区：
文献类型：
--
作者：
Capone, A.;Giannella, M.;Petrosillo, N.
耐碳青霉烯类肺炎克雷伯菌(CR-KP)正成为意大利医疗保健相关感染的常见原因，具有很高的发病率和死亡率。流行的CR-KP克隆和抗性机制因地区和时间的不同而不同。必须调查治疗方法及其对死亡率的影响。我们对2010年12月至2011年5月在意大利罗马9家医院住院的CR-KP分离患者进行了前瞻性研究，以描述分子流行病学、抗生素治疗和死亡率的风险因素。总体而言，97名患者(60%为男性，中位年龄69岁)入选。89例患者鉴定出blaKPC-3菌株，3例患者鉴定出blaVIM菌株，其余5例患者鉴定出blaCTX-M-15加孔洞缺陷菌株。发现两个主要克隆ST512和ST258在医院间传播。总体而言，36.1%和20.4%的菌株对粘菌素和替吉环素也有耐药性。91例患者在接受适当的抗生素治疗、联合治疗和清除感染源后被诊断为感染，分别为73.6%、59.3%和28.5%。总体而言，开出了23种不同的抗生素方案。住院死亡率为25.8%。经适当治疗、联合治疗和清除感染源调整后的多因素分析显示，Charlson合并症评分、重症监护病房感染、菌血症和耐粘菌素CR-KP菌株感染是死亡的独立危险因素。产生肺炎克雷伯菌碳青霉烯酶克隆的传播，主要是ST258，目前是意大利中部CR-KP感染的主要原因。我们观察到对粘菌素的高耐药率与较差的结果独立相关。
Carbapenem-resistant Klebsiella pneumoniae (CR-KP) is becoming a common cause of healthcare-associated infection in Italy, with high morbidity and mortality. Prevalent CR-KP clones and resistance mechanisms vary between regions and over time. Therapeutic approaches and their impact on mortality have to be investigated. We performed a prospective study of patients with CR-KP isolation, hospitalized in nine hospitals of Rome, Italy, from December 2010 to May 2011, to describe the molecular epidemiology, antibiotic treatment and risk factors for mortality. Overall, 97 patients (60% male, median age 69 years) were enrolled. Strains producing blaKPC-3 were identified in 89 patients, blaVIM in three patients and blaCTX-M-15 plus porin defects in the remaining five patients. Inter-hospital spread of two major clones, ST512 and ST258, was found. Overall, 36.1% and 20.4% of strains were also resistant to colistin and tigecycline, respectively. Infection was diagnosed in 91 patients who received appropriate antibiotic treatment, combination therapy and removal of the infectious source in 73.6%, 59.3% and 28.5% of cases, respectively. Overall, 23 different antibiotic regimens were prescribed. In-hospital mortality was 25.8%. Multivariate analysis adjusted for appropriate treatment, combination therapy and infectious-source removal, showed that Charlson comorbidity score, intensive-care unit onset of infection, bacteraemia and infection due to a colistin-resistant CR-KP strain were independent risk factors for mortality. The spread of clones producing K. pneumoniae carbapenemases, mainly ST258, is currently the major cause of CR-KP infection in central Italy. We observed a high rate of resistance to colistin that is independently associated with worse outcome.