Clinical features of patients with carbapenem nonsusceptible Klebsiella pneumoniae and Escherichia coli in intensive care units: A nationwide multicenter study in Taiwan
Journal
Journal of Microbiology, Immunology and Infection
Journal Volume
48
Journal Issue
2
Pages
219-225
Date Issued
2015
Author(s)
Chang Y.-Y.
Chuang Y.-C.
Siu L.K.
Wu T.-L.
Lin J.-C.
Lu P.-L.
Wang L.-S.
Lin Y.-T.
Huang L.-J.
Fung C.-P.
Abstract
Patients in intensive care units (ICUs) are especially prone to colonization and infection by carbapenem-resistant Enterobacteriaceae. We conducted a multicenter investigation to study the clinical and microbiological characteristics of patients with carbapenem nonsusceptible Klebsiella pneumoniae and Escherichia coli in ICUs of Taiwanese hospitals. Methods: Patients with carbapenem nonsusceptible K. pneumoniae and E. coli in ICUs from nine medical centers and eight regional hospitals in Taiwan were enrolled in 2012. Carbapenem nonsusceptibility was defined as a minimum inhibitory concentration of at least 2mg/L for imipenem or meropenem. Clinical characteristics and risk factors for 30-day mortality were analyzed. Isolates were screened for antibiotic susceptibility and β-lactamase genes. Results: A total of 66 cases infected (. n=46) or colonized (. n=20) with carbapenem nonsusceptible K. pneumoniae (. n=60) and E. coli (. n=6) were identified during the study period. Nineteen isolates had genes that encoded carbapenemases (28.8%), including Klebsiella pneumoniae carbapenemase-2 (KPC-2) (. n=14), imipenemase-8 (IMP-8) (. n=1), Verona integron-encoded metallo-β-lactamase (VIM) (. n=3), and New Delhi metallo-β-lactamase-1 (NDM-1) (. n=1). The in-hospital mortality associated with non-susceptible K. pneumoniae and E. coli was 50%. The 30-day mortality of the 46 patients with infection was 50%. Septic shock was the only independent risk factor for 30-day mortality in patients with infection. The 30-day mortality rate was similar between patients with combination therapy and monotherapy. Conclusion: Patients who acquired carbapenem nonsusceptible K. pneumoniae and E. coli in ICUs have a high mortality rate. Further clinical study is needed to deal with this emerging challenge.
SDGs
Publisher
Elsevier Ltd
Type
journal article