Comparison of clinical characteristics and outcome of carbapenem sensitive and carbapenem resistant Klebsiella Species infection from a Tertiary-Care-Hospital, Karachi, Pakistan
DOI:
https://doi.org/10.61529/idjp.v33i4.337Abstract
Background: The prevalence of carbapenem-resistant (CR) Klebsiella species (KS) exceeds 60% in South Asia, leading to high morbidity and mortality. Data on KS clinical aspects from Pakistan is limited. This study aimed to examine the clinical characteristics, outcomes, and mortality risk factors associated with KS-infections.
Material and Methods: A prospective study conducted between September 2022 and March 2023 compared patients with carbapenem-resistant KS (CR-KS) and carbapenem-susceptible KS (CS-KS) in terms of demographics, clinical features, Charlson comorbidity index, source of infection, previous hospitalization, source control, and receipt of appropriate empirical antibiotics. Outcomes were recorded as admission status, discharge, or death at day 14.
Results: A study of 217 patients with a median age of 48 years found that 52% had a history of prior hospitalization, and 47.5% presented with bacteremia. Carbapenem-resistant KS (CRKS) was present in 58.9% of patients. CR-KS infection was significantly linked to recent hospitalization (p=0.01), fever (p=0.01), altered mental status (p=0.002), ICU admission (p=0.003), mechanical ventilation (p= 0.02), and pneumonia (p=0.004). CR-KS had poor bacterial clearance and a low rate of appropriate empirical antibiotic use (3.2%). At day 14, the all-cause mortality rate was 29%, with significantly higher mortality in CRKS patients, as shown by the survival curve. Multivariate analysis indicated that CR-KS patients did not receive appropriate empirical antibiotics.
Conclusion: The study revealed a high prevalence of CR-KS infections associated with significant morbidity and mortality. Patients with CRKS infection did not receive appropriate empirical antibiotics. Timely availability of antibiogram with good infection control practices are critical in preventing mortality and spread this highly pathogenic organism.
Keywords: Carbapenem resistant, Klebsiella, Antimicrobial resistance
References
Gorrie CL, Mirčeta M, Wick RR, Judd LM, Lam MM, Gomi R, et al. Genomic dissection of Klebsiella pneumoniae infections in hospital patients reveals insights into an opportunistic pathogen. 2022;13(1):3017. DOI: https://doi.org/10.1038/s41467-022-30717-6
Reid CB, Steele L, Pasquill K, Parfitt EC, Laupland KB. Occurrence and determinants of Klebsiella species bloodstream infection in the western interior of British Columbia, Canada. BMC Infect Dis. 2019; 19(1): 1070. DOI: https://doi.org/10.1186/s12879-019-4706-8
Dong N, Yang X, Chan EW, Zhang R, Chen S. Klebsiella species: Taxonomy, hypervirulence and multidrug resistance. EBioMedicine. 2022; 79: 103998. DOI: https://doi.org/10.1016/j.ebiom.2022.103998
Shon AS, Russo TA. Hypervirulent Klebsiella pneumoniae: the next superbug? Future Microbiol. 2012; 7(6): 669-71. DOI: https://doi.org/10.2217/fmb.12.43
Paczosa MK, Mecsas J. Klebsiella pneumoniae: Going on the offense with a strong defense. Microbiol Mol Biol Rev. 2016; 80(3): 629-61. DOI: https://doi.org/10.1128/mmbr.00078-15
Lin XC, Li CL, Zhang SY, Yang XF, Jiang M. The global and regional prevalence of hospital-acquired carbapenem-resistant Klebsiella pneumoniae infection: A systematic review and meta-analysis. Open Forum Infect Dis. 2024; 11(2): ofad649. DOI: https://doi.org/10.1093/ofid/ofad649
Falagas ME, Rafailidis PI, Kofteridis D, Virtzili S, Chelvatzoglou FC, Papaioannou V, et al. Risk factors of carbapenem-resistant Klebsiella pneumoniae infections: a matched case–control study. J Antimicrob Chemother. 2007; 60(5): 1124-30. DOI: https://doi.org/10.1093/jac/dkm356
Li Y, Li J, Hu T, Hu J, Song N, Zhang Y, et al. Five-year change of prevalence and risk factors for infection and mortality of carbapenem-resistant Klebsiella pneumoniae bloodstream infection in a tertiary hospital in North China. Antimicrob Resist Infect Control. 2020; 9: 1-14. DOI: https://doi.org/10.1186/s13756-020-00728-3
Hsu LY, Apisarnthanarak A, Khan E, Suwantarat N, Ghafur A, Tambyah PA. Carbapenem-resistant Acinetobacter baumannii and Enterobacteriaceae in south and southeast Asia. Clin Microbiol Rev. 2017;30(1):1-22. DOI: https://doi.org/10.1128/cmr.masthead.30-1
Zhu WM, Yuan Z, Zhou HY. Risk factors for carbapenem-resistant Klebsiella pneumoniae infection relative to two types of control patients: a systematic review and meta-analysis. Antimicrob Resist Infect Control. 2020; 9(1): 23. DOI: https://doi.org/10.1186/s13756-020-0686-0
Zhang H, Wang J, Zhou W, Yang M, Wang R, Yan X, et al. Risk factors and prognosis of carbapenem-resistant Klebsiella pneumoniae infections in respiratory intensive care unit: a retrospective study. Infect Drug Resist. 2021: 3297-305. DOI: https://doi.org/10.2147/idr.s317233
Wang Z, Qin RR, Huang L, Sun L-YJ. Risk factors for carbapenem-resistant Klebsiella pneumoniae infection and mortality of Klebsiella pneumoniae infection. Chin Med J (Engl). 2018; 131(01): 56-62.
DOI: https://doi.org/10.4103/0366-6999.221267
Chen J, Ma H, Huang X, Cui Y, Peng W, Zhu F, et al. Risk factors and mortality of carbapenem-resistant Klebsiella pneumoniae bloodstream infection in a tertiary-care hospital in China: An eight-year retrospective study. Antimicrob Resist Infect Control. 2022; 11(1): 161.
DOI: https://doi.org/10.1186/s13756-022-01204-w
Fatima M, Dodani SK, Babar ZU, Badlani S, Rani B, Mushtaq M, et al. Outcome, risk factors and therapeutic strategies in carbapenem-resistant Gram-negative bacteraemia from Pakistan. JAC Antimicrob Resist. 2023; 5(3): dlad076. DOI: https://doi.org/10.1093/jacamr/dlad076
CLSI. Performance Standards for Antimicrobial Susceptibility Testing. 2020;Thirty Edition: M100. 2020. Available from: https://www.nih.org.pk/wp-content/uploads/2021/02/CLSI-2020.pdf
Control CfD, Accessed PJC. CDC/ NHSN surveillance definitions for specific types of infections. 2014: 25.
Available at: https://www.socinorte.com/wp-content/uploads/2014/06/17pscNosInfDef_current.pdf
Juan CH, Fang SY, Chou CH, Tsai TY, Lin YT. Clinical characteristics of patients with pneumonia caused by Klebsiella pneumoniae in Taiwan and prevalence of antimicrobial-resistant and hypervirulent strains: A retrospective study. Antimicrob Resist Infect Control. 2020; 9(1): 4. DOI: https://doi.org/10.1186/s13756-019-0660-x
Zhao Q, Guo L, Wang LF, Zhao Q, Shen DX. Prevalence and characteristics of surgical site hypervirulent Klebsiella pneumoniae isolates. 2020; 34(9): e23364. DOI: https://doi.org/10.1002/jcla.23364
Qureshi ZA, Syed A, Clarke LG, Doi Y, Shields RKJAa, chemotherapy. Epidemiology and clinical outcomes of patients with carbapenem-resistant Klebsiella pneumoniae bacteriuria. Antimicrob Agents Chemother. 2014; 58(6): 3100-4. DOI: https://doi.org/10.1128/aac.02445-13
Zhu W, Yuan Z, Zhou H. Risk factors for carbapenem-resistant Klebsiella pneumoniae infection relative to two types of control patients: a systematic review and meta-analysis. Antimicrob Resist Infect Control. 2020; 9(1): 23.
DOI: https://doi.org/10.1186/s13756-020-0686-0
Imtiaz W, Syed Z, Rafaque Z, Andrews SC, Dasti JI. Analysis of antibiotic resistance and virulence traits (genetic and phenotypic) in Klebsiella pneumoniae clinical isolates from Pakistan: Identification of significant levels of Carbapenem and Colistin Resistance. Infect Drug Resist. 2021; 14: 227-36. DOI: https://doi.org/10.2147/idr.s293290
Aslam B, Chaudhry TH, Arshad MI, Muzammil S, Siddique AB, Yasmeen N, et al. Distribution and genetic diversity of multi-drug-resistant Klebsiella pneumoniae at the human-animal-environment interface in Pakistan. Front Microbiol. 2022; 13: 898248. DOI: https://doi.org/10.3389/fmicb.2022.898248
Gondal AJ, Saleem S, Jahan S, Choudhry N, Yasmin N. Novel carbapenem-resistant Klebsiella pneumoniae ST147 coharboring bla (NDM-1), bla (OXA-48) and extended-spectrum beta-lactamases from Pakistan. Infect Drug Resist. 2020; 13: 2105-15. DOI: https://doi.org/10.2147/idr.s251532
Kuzina ES, Kislichkina AA, Sizova AA, Skryabin YP, Novikova TS, Ershova ON, et al. High-molecular-weight plasmids carrying carbapenemase genes bla (NDM-1), bla (KPC-2), and bla(OXA-48) coexisting in clinical Klebsiella pneumoniae Strains of ST39. Microorganisms. 2023; 11(2): 459. DOI: https://doi.org/10.3390/microorganisms11020459
Iskandar K, Molinier L, Hallit S, Sartelli M, Catena F, Coccolini F, et al. Drivers of antibiotic resistance transmission in low- and middle-income countries from a "One Health" perspective-A review. Antibiotics (Basel). 2020; 9(7): 372.
DOI: https://doi.org/10.3390/antibiotics9070372
Podschun R, Ullmann U. Klebsiella spp. as nosocomial pathogens: epidemiology, taxonomy, typing methods, and pathogenicity factors. Clin Microbiol Rev. 1998; 11(4): 589-603. DOI: https://doi.org/10.1128/cmr.11.4.589
Rao K, Patel A, Sun Y, Vornhagen J, Motyka J, Collingwood A, et al. Risk factors for Klebsiella infections among hospitalized patients with preexisting colonization. mSphere. 2021; 6(3): e0013221. DOI: https://doi.org/10.1128/msphere.00132-21
Vidal-Cortes P, Martin-Loeches I, Rodriguez A, Bou G, Canton R, Diaz E, et al. Current positioning against severe infections due to Klebsiella pneumoniae in hospitalized adults. Antibiotics (Basel). 2022; 11(9): 1160.
DOI: https://doi.org/10.3390/antibiotics11091160
Marquet K, Liesenborgs A, Bergs J, Vleugels A, Claes N. Incidence and outcome of inappropriate in-hospital empiric antibiotics for severe infection: A systematic review and meta-analysis. 2015; 19: 63. DOI: https://doi.org/10.1186/s13054-015-0795-y
Babar ZU, Dodani SK, Nasim A. Treatment outcome and adverse effects of colistin in adult patients with carbapenem-resistant gram-negative bacteremia from Pakistan. Int J Infect Dis. 2021; 106: 171-5. DOI: https://doi.org/10.1016/j.ijid.2021.03.004
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