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Carbapenem Resistance Among Klebsiella pneumoniae Isolates Risk Factors, Molecular Characteristics, and Susceptibility Patterns

Published online by Cambridge University Press:  02 January 2015

Khetam Hussein ,
Hanna Sprecher ,
Tania Mashiach ,
Ilana Oren ,
Imad Kassis  and
Renato Finkelstein
Khetam Hussein
Affiliation:
Infectious Diseases Unit, Haifa, Israel
Hanna Sprecher
Affiliation:
Clinical Microbiology Department, Haifa, Israel
Tania Mashiach
Affiliation:
Infectious Diseases Unit, Haifa, Israel
Ilana Oren
Affiliation:
Infectious Diseases Unit, Haifa, Israel Rambam Medical Center, and the Bruce Rapport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
Imad Kassis
Affiliation:
Infectious Diseases Unit, Haifa, Israel Rambam Medical Center, and the Bruce Rapport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
Renato Finkelstein*
Affiliation:
Infectious Diseases Unit, Haifa, Israel Rambam Medical Center, and the Bruce Rapport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
*
Infectious Diseases Unit, Rarabam Medical Center, 31096-Bat Galim, Haifa (rfinkelstein@rambam.health.gov.il)
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Abstract

Background.

Carbapenem resistance among isolates of Klebsiella pneumoniae has been unusual.

Objectives.

To identify risk factors for infection with carbapenem-resistant K. pneumoniae (CRKP) and to characterize microbiological aspects of isolates associated with these infections.

Design.

Retrospective case-control study.

Setting.

A 900-bed tertiary care hospital.

Results.

From January 2006 through April 2007, K. pneumoniae was isolated from 461 inpatients; 88 had CRKP infection (case patients), whereas 373 had carbapenem-susceptible K. pneumoniae infection (control subjects). The independent risk factors for infection with CRKP were prior fluoroquinolone use (odds ratio [OR], 1.87 [95% confidence interval {CI}, 1.07–3.26]; P = .026), previous receipt of a carbapenem drug (OR, 1.83 [95% CI, 1.02–3.27]; P = .042), admission to the intensive care unit (OR, 4.27 [95% CI, 2.49–7.31]; P < .001), and exposure to at least 1 antibiotic drug before isolation of K. pneumoniae (OR, 3.93 [95% CI, 1.15–13.47]; P = .029). All CRKP isolates carried the blaKPC gene. Approximately 90% of the tested isolates carried the blaKPC-2 allele, suggesting patient-to-patient transmission. Almost all CRKP isolates were resistant to all antibiotics, except to Colistin (resistance rate, 4.5%), gentamicin (resistance rate, 7%), and tigecycline (resistance rate, 15%).

Conclusions.

CRKP should be regarded as an emerging clinical threat. Because these isolates are resistant to virtually all commonly used antibiotics, control of their spread is crucial.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 7 , July 2009 , pp. 666 - 671
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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