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Risk factors and mortality in the Carbapenem-resistant Klebsiella pneumoniae infection: case control study
Fethiye Akgul,Hakan Leblebicioglu,Ilkay Bozkurt,Mustafa Sunbul,Saban Esen
- , 2016, DOI: 10.1080/20477724.2016.1254976
Abstract: Carbapenem-resistant Klebsiella pneumoniae (CRKP) has been known as a nosocomial pathogen, both for the last 10 years in Turkey and for 20 years worldwide. Due to limited treatment options and high mortality rates, despite improvements in the field of medicine at the present time, CRKP is still a big threat for public health. This study was carried out between the dates of January 2010 and September 2014. Patients ≥18 who were hospitalized for at least 72 h and who also had CRKP growth were included in the study as a case group. In the same period patients, who were hospitalized in the same ward and did not have CRKP growth were selected as the control group. It was determined that no glycopeptides and steroids use nor tracheostomy as protective factors would be employed in terms of non-development of CRKP. Mechanical ventilation, tracheostomy, urinary catheter presence, central venous catheterization, nasogastric tube placement, advanced age, acute renal insufficiency, total parenteral nutrition, carbapenem, glycopeptide, and piperacillin tazobactam were all detected as risk factors in terms of CRKP infection development. As a result, rational usage of antibiotics for preventing infections developing with CRKP should be targeted
耐碳氢酶烯肺炎克雷伯杆菌肺部感染后进展为急性呼吸窘迫综合症的临床特征及Nomogram预测模型构建
Clinical Features and Nomogram Prediction Model Construction for Progression to Acute Respiratory Distress Syndrome after Carbapenem-Resistant Klebsiella pneumoniae (CRKP) Lung Infection  [PDF]
随秀华, 赵晶晶, 姚莉, 王菁
Advances in Clinical Medicine (ACM) , 2023, DOI: 10.12677/ACM.2023.1392074
Abstract: 目的：分析耐碳青霉烯类肺炎克雷伯杆菌(Carbapenem-resistant Klebsiella pneumoniae, CRKP)肺部感染后进展为急性呼吸窘迫综合症(Acute respiratory distress syndrome, ARDS)的临床特征以及构建Nomogram模型。方法：回顾性收集合肥市第二人民医院2019年01月~2022年12月所有肺部感染后肺泡灌洗液分离出CRKP的患者共162例，其中有71例患者CRKP肺部感染后进展为ARDS，此为ARDS组；91例患者CRKP肺部感染后未进展为ARDS，此为非ARDS组。使用SPASS 26.0软件对于收集的患者的临床资料进行单因素以及Logistic多因素分析，受试者工作特征(receiver operator char-acteristic, ROC)曲线分析各指标诊断耐CRKP肺部感染后进展为ARDS的危险因素最佳截断值以及曲线下面积(area under the ROC curve, AUC)。并以此为基础应用R软件“rms”包构建其Nomogram模型，校正曲线对Nomogram模型进行内部验证，应用R软件“rmda”包构建决策曲线，并评估Nomogram模型的预测效能。P < 0.05为差异有统计学意义。结果：单因素分析提示，与非ARDS组相比，ARDS组患者的年龄、高血压病史、吸烟史、慢性阻塞性肺疾病(COPD)病史、查尔森共病指数评分(Charlson comorbidity index, CCI)、序贯器官衰竭评分(Sequential Organ Failure Assessment, SOFA)、肺炎严重程度评分(Pneumonia Severity Index, PSI)、入院第3天CRP计数、CRP/白蛋白比值(第3天)等10项指标差异均有统计学意义(P < 0.05)；多因素Logistic回归分析显示，与非ARDS组相比，ARDS组患者的年龄[OR = 1.307, 95% CI (1.005~1.069)]、SOFA评分[OR = 1.376, 95% CI (1.176~1.610)]、CCI评分[OR = 1.268, 95% CI (1.067~1.507)]具有统计学差异(P < 0.05)，是CRKP肺部感染后进展为ARDS的独立危险因素；将两组中有统计学意义的连续变量进行ROC曲线分析可知，患者年龄、SOFA评分、CCI评分的AUC分别为0.641、0.710、0.669；最佳截断值分别为67.5岁、1.5分、3.5分。Nomogram模型校正曲线及临床净收益分析：内部验证结果显示预测肺部感染CRKP后进展为ARDS的风险C-index为0.728 (95% CI: 0.656~0.801)，校正C-index为0.717。校准曲线显示观测值与预测值之间一致性较好。决策曲线结果显示，当风险阈值波动在0.367~0.567时，Nomogram模型提供临床净收益；此外，Nomogram模型临床净收益均高于年龄、SOFA评分、CCI评分。结论：年龄(>67.5岁)、SOFA (>1.5分)、CCI (>3.5分)是CRKP肺部感染后发生ARDS的独立危险因素(P < 0.05)。本研究基于此构建的Nomogram模型对于肺部感染肺炎克雷伯杆菌后进展为ARDS的早期诊断、早期干预提供了重要的指导意义。
Objective: To analyze the clinical features of progression to acute respiratory distress syndrome (ARDS) after Carbapenem-resistant Klebsiella pneumoniae (CRKP) lung infection and Nomogram model was constructed. Methods: A total of 162 patients with CRKP isolated from alveolar lavage fluid after all lung infections were retrospectively collected in the Second People’s Hospital of Hefei City from January 2019 to December 2022, of which 71 patients progressed to ARDS after CRKP lung infection, which is the ARDS group, and 91 patients did not progress to ARDS after CRKP lung infection, which is the non-ARDS group. Using SPASS 26.0 software, the clinical data collected from the patients were analyzed by single-factor and logistic multifactorial analysis, and the receiver op-erator characteristic (ROC) curves were analyzed to determine the optimal cut-off value of the risk factors for progression to ARDS after diagnosis of CRKP-resistant lung infections as well as the area under the ROC curve (AUC). The Nomogram model was constructed using the R software “rms” package, the calibration curves were used for internal validation of
耐碳青霉烯肺炎克雷伯菌临床特征与危险因素
Clinical Features and Risk Factors of Carbapenem-Resistant Klebsiella pneumoniae  [PDF]
靳洋洋, 孔雪莲, 吴晓晗, 唐吉元昊, 黄颖
Bioprocess (BP) , 2025, DOI: 10.12677/bp.2025.151002
Abstract: 目的：通过分析住院患者耐碳青霉烯肺炎克雷伯菌(Carbapenem-resistant Klebsiella pneumoniae, CRKP)的临床特征与危险因素，旨在为CRKP的诊断和治疗给予理论支撑。方法：采用回顾性研究方法选取安徽医科大学第一附属医院2023年6月至2024年7月住院患者分离出的肺炎克雷伯菌(Klebsiella pneumoniae, KP)。按菌株对碳青霉烯类药物的敏感性划分成两个组别：碳青霉烯敏感肺炎克雷伯菌(Carbapenem-susceptible Klebsiella pneumoniae, CSKP)组(n = 106)与CRKP组(n = 74)。收集所有研究对象的临床数据，并采用单因素分析和多因素logistic回归分析来分析住院患者发生CRKP的危险因素，明确各因素之间的关联以及对感染风险的影响程度，为后续的预防和控制感染提供科学依据。结果：180例KP患者中检出CRKP 74例，其中男性43例，女性31例。CRKP菌株主要来自重症医学科，其次为感染科和康复科，标本主要来源于痰液、血液和尿液。单因素分析显示，住院天数 ≥ 10天、肺部疾病、泌尿道感染、入住ICU史、入住ICU ≥ 5天、抗生素使用 > 14天、联用抗生素、呼吸机、尿道插管、中心静脉置管、气管镜检、胃管置入均与CRKP感染有关(p < 0.05)。多因素分析结果显示，泌尿道感染、抗生素使用 > 14天、中心静脉置管为CPKP感染的独立危险因素。结论：泌尿道感染、抗生素使用 > 14天、中心静脉置管是导致CRKP菌株感染形成的独立危险因素，在临床防治CRKP感染中应加以重视。
Objective: To analyze the clinical characteristics and risk factors of Carbapenem-resistant Klebsiella pneumoniae (CRKP) in hospitalized patients, aiming to give theoretical support for the diagnosis and treatment of CRKP. Methods: Klebsiella pneumoniae (KP) isolated from patients hospitalized in the First Affiliated Hospital of Anhui Medical University from June 2023 to July 2024 were selected using a retrospective study. The strains were divided into two groups according to their susceptibility to carbapenems: the carbapenem-susceptible Klebsiella pneumoniae (CSKP) group (n = 106) versus the CRKP group (n = 74). Clinical data of all study subjects were collected. Univariate analysis and logistic regression analysis were used to analyze the risk factors for the occurrence of CRKP in hospitalized patients, to clarify the association between the characteristics and the degree of influence on the risk of infection, and to provide a scientific basis for the subsequent prevention and control of infection. Results: CRKP was detected in 74 of 180 KP patients, including 43 males and 31 females. CRKP strains were mainly from the Department of Intensive Care Medicine, followed by the Department of Infectious Diseases and the Department of Rehabilitation, and specimens were mainly from sputum, blood, and urine. Univariate analysis showed that hospitalization days ≥ 10 days, pulmonary disease, urinary tract infection, history of ICU stay, ICU stay ≥ 5 days, antibiotic use > 14 days, combined antibiotics, ventilator, urethral intubation, central venous catheterization, tracheoscopy, and gastric tube placement were all associated with
A hospital-based matched case–control study to identify clinical outcome and risk factors associated with carbapenem-resistant Klebsiella pneumoniae infection
Correa Luci,Martino Marines Dalla Valle,Siqueira Itacy,Pasternak Jacyr
BMC Infectious Diseases , 2013, DOI: 10.1186/1471-2334-13-80
Abstract: Background Healthcare-associated infections caused by Klebsiella pneumoniae isolates are increasing and few effective antibiotics are currently available to treat patients. We observed decreased carbapenem susceptibility among K. pneumoniae isolated from patients at a tertiary private hospital that showed a phenotype compatible with carbapenemase production although this group of enzymes was not detected in any sample. The aim of this study was to describe the epidemiology and clinical outcomes associated with carbapenem-resistant K. pneumoniae and to determine the antimicrobial resistance mechanisms. Methods Risk factors associated with carbapenem-resistant K. pneumoniae infections were investigated by a matched case–control study from January 2006 through August 2008. A cohort study was also performed to evaluate the association between carbapenem resistance and in-hospital mortality. Bacterial identification and antimicrobial susceptibility were determined by Vitek 2 and Etest. Carbapenemase activity was detected using spectrophotometric assays. Production of beta-lactamases and alterations in genes encoding K. pneumoniae outer membrane proteins, OmpK35 and OmpK36, were analyzed by PCR and DNA sequencing, as well as SDS-Page. Genetic relatedness of carbapenem resistant isolates was evaluated by Pulsed Field Gel Electrophoresis. Results Sixty patients were included (20 cases and 40 controls) in the study. Mortality was higher for patients with carbapenem-resistant K. pneumoniae infections compared with those with carbapenem-susceptible K. pneumoniae (50.0% vs 25.7%). The length of central venous catheter use was independently associated with carbapenem resistance in the multivariable analysis. All strains, except one, carried blaCTX-M-2, an extended-spectrum betalactamase gene. In addition, a single isolate also possessed blaGES-1. Genes encoding plasmid-mediated AmpC beta-lactamases or carbapenemases (KPC, metallo-betalactamases or OXA-carbapenemases) were not detected. Conclusions The K. pneumoniae multidrug-resistant organisms were associated with significant mortality. The mechanisms associated with decreased K. pneumoniae carbapenem susceptibility were likely due to the presence of cephalosporinases coupled with porin alterations, which resulted from the presence of the insertion sequences in the outer membrane encoding genes.
Endotoxin neutralization by an O-antigen specific monoclonal antibody: A potential novel therapeutic approach against Klebsiella pneumoniae ST258
Adriana Badarau,Cecília Varga,Christine A. Power,Eszter Nagy,Gábor Nagy,Irina Mirkina,Katharina Hartl,Luis M. Guachalla,Lukas Stulik,Valéria Szijártó,Zehra C. Visram
- , 2017, DOI: 10.1080/21505594.2017.1279778
Abstract:
Identification and Characterization of NDM-1-producing Hypervirulent (Hypermucoviscous) Klebsiella pneumoniae in China
Jiabin Li,Xin Li,Yanyan Liu,Yi Gu,Ying Ye,Zhou Liu
- , 2019, DOI: 10.3343/alm.2019.39.2.167
Abstract: Carbapenem-resistant hypervirulent (hypermucoviscous) Klebsiella pneumoniae (CR-HMKP) poses a significant public health challenge. We investigated its epidemiology and molecular characteristics in a tertiary care hospital in eastern China
Multidrug Resistance Mechanisms of Carbapenem Resistant Klebsiella pneumoniae Strains Isolated in Chongqing, China
Jing Shi,Jinrong Yan,Liping Zhang,Shan Sun,Shuangshuang Yang,Shuli Pu,Xiaojiong Jia,Xiuyu Xu
- , 2017, DOI: 10.3343/alm.2017.37.5.398
Abstract:
Gut Microbiota and Clinical Features Distinguish Colonization With Klebsiella pneumoniae Carbapenemase-Producing Klebsiella pneumoniae at the Time of Admission to a Long-term Acute Care Hospital
Anna M Seekatz,Centers for Disease Control and Prevention Epicenters Program,Christine M Bassis,Karen Lolans,Louis Fogg,Mary K Hayden,Michael Y Lin,Nicholas M Moore,Robert A Weinstein,Vincent B Young,Yoona Rhee
- , 2018, DOI: 10.1093/ofid/ofy190
Abstract: Identification of gut microbiota features associated with antibiotic-resistant bacterial colonization may reveal new infection prevention targets
A Prospective Observational Study of the Epidemiology, Management, and Outcomes of Skin and Soft Tissue Infections Due to Carbapenem-Resistant Enterobacteriaceae
Andrea M Hujer,David van Duin,Eric Cober,Federico Perez,Keith S Kaye,Kristine M Hujer,Oryan Henig,Richard R Watkins,Robert A Bonomo,Robert A Salata,Robert C Kalayjian,Sandra S Richter,Scott Evans,Steve Marshall,Susan D Rudin,T Nicholas Domitrovic,Vance G Fowler, Jr.,Yohei Doi,for the Antibacterial Resistance Leadership Group
- , 2017, DOI: 10.1093/ofid/ofx157
Abstract:
Carbapenem-Resistant Enterobacteriaceae Infections in Patients on Renal Replacement Therapy
Antibacterial Resistance Leadership Group,Barry Kreiswirth,Brandon Eilertson,David van Duin,Eric Cober,Federico Perez,Jack DeHovitz,Keith S Kaye,Richard R Watkins,Robert A Bonomo,Robert A Salata,Robert C Kalayjian,Sandra S Richter,Scott Evans,Vance G Fowler, Jr.,Yohei Doi
- , 2017, DOI: 10.1093/ofid/ofx216
Abstract: Patients on chronic intermittent renal replacement therapy (RRT) are at risk for infection with carbapenem-resistant Enterobacteriaceae (CRE). However, the impact of RRT on outcomes after CRE infections remains to be defined. Here we perform a comparison of outcomes for CRE-infected patients with preserved renal function compared with CRE-infected patients on RRT
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