Clinical Outcomes, Microbiological Characteristics and Risk Factors for Difficult-to-Treat Resistance to Klebsiella pneumoniae Infection

• Published in: Infection and drug resistance Vol. 15; pp. 5959 - 5969
• Main Authors: Yang, Ping, Liu, Chao, Wu, Zhenchao, Zheng, Jiajia, Yi, Juan, Wu, Nan, Wu, Zhangli, Lu, Ming, Cui, Liyan, Shen, Ning
• Format: Journal Article
• Language: English
• Published: Macclesfield Dove Medical Press Limited 01.01.2022; Taylor & Francis Ltd; Dove; Dove Medical Press
• Subjects: Antibiotics; Antimicrobial agents; Bacterial pneumonia; Cerebrovascular diseases; China; Clinical outcomes; Comorbidity; difficult-to-treat resistance; Disease; DNA sequencing; Drug resistance; Genetic aspects; Genomes; Genomics; Hospitals; Imipenem; Klebsiella pneumoniae; Mechanical ventilation; Mortality; Nosocomial infections; Nucleotide sequence; Nucleotide sequencing; Original Research; Patient outcomes; Patients; Phenotypes; Pneumonia; Regression analysis; Research ethics; risk factor; Risk factors; Serotypes; Software; Surveillance; Virulence; Virulence (Microbiology); Whole genome sequencing; China; France
• ISSN: 1178-6973; 1178-6973
• DOI: 10.2147/IDR.S377064

Purpose: This study aimed to identify the clinical outcomes, microbiological features and risk factors for difficult-to-treat resistance (DTR) Klebsiella pneumoniae (Kp) infection. Materials and Methods: A retrospective study was conducted at Peking University Third Hospital from January 2020 to March 2021. DTR was defined as resistance to [greater than or equal to]1 carbapenem, [greater than or equal to]1 extended-spectrum cephalosporin, and [greater than or equal to]1 fluoroquinolone. Hypervirulent Kp (HvKp) was defined as peg-344-, iroB-, iucA-, rmpA-, or rmpA2-positive. Clinical data were collected. Antimicrobial susceptibility testing and string tests were performed to determine resistance and hypermucoviscosity phenotype. Whole genome sequencing was performed to analyze the sequence type (ST), capsular serotypes, resistance and virulence genes. Risk factors for 30-day mortality were analyzed. Results: Fifty DTR-Kp (50.0%) strains were identified among 100 patients. Compared to non-DTR-Kp group, a significant number of patients with DTR-Kp infection experienced ICU admission (44.0% versus 10.0%, P<0.001) and mechanical ventilation after Kp detection (26.0% versus 10.0%, P=0.037). Notably, the percentage of hvKp among the DTR-Kp isolates increased consistently over the 15 months evaluated. Most DTR-Kp strains belonged to ST11 (82.0%), followed by ST15 (12.0%), ST86 (2.0%), ST996 (2.0%), and ST3157 (2.0%). DTR-Kp isolates possessed various resistance genes, such as [bla.sub.KPC-2], [bla.sub.TEM-1D] and fosA3 (90.0%, 80.0% and 72.0%, respectively). Importantly, the yersiniabactin genes were significantly clustered in DTR group (48/50, 96.0%). The 30-day mortality was significantly higher in patients with DTR-Kp infection than non-DTR-Kp group (38.0% versus 8.2%, P=0.001). DTR-Kp infection (odds ratio [OR] = 4.196) was an independent risk factor for the 30-day mortality of Kp-infected patients. Additionally, cerebrovascular disease (OR = 2.780) and Charlson comorbidity index (OR= 1.584) were independent risk factors for DTR-Kp infections. Conclusion: DTR-hvKp is rapidly emerging. The DTR-Kp strains harbored various resistance genes and high rates of yersiniabactin siderophore genes. DTR-Kp infection was an independent risk factor for mortality, suggesting that enhanced awareness essential. Keywords: Klebsiella pneumoniae, difficult-to-treat resistance, mortality, risk factor