Molecular epidemiology and risk factors for colistin- or tigecycline-resistant carbapenemase-producing Klebsiella pneumoniae bloodstream infection in critically ill patients during a 7-year period

• Published in: Diagnostic microbiology and infectious disease 2018-11, Vol.92 (3), p.235-240
• Main Authors: Papadimitriou-Olivgeris, Matthaios, Bartzavali, Christina, Spyropoulou, Aikaterini, Lambropoulou, Anastasia, Sioulas, Nektarios, Vamvakopoulou, Sophia, Karpetas, Georgios, Spiliopoulou, Iris, Vrettos, Theofanis, Anastassiou, Evangelos D., Fligou, Fotini, Christofidou, Myrto, Marangos, Markos
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - pharmacology; Bacteremia; Bacterial Proteins - genetics; beta-Lactamases - genetics; Case-Control Studies; Colistin - pharmacology; Comorbidity; Critical Care; Critical Illness - epidemiology; Drug Resistance, Bacterial; Female; Genotype; Humans; Intensive care unit; Intensive Care Units; Klebsiella Infections - drug therapy; Klebsiella Infections - epidemiology; Klebsiella Infections - microbiology; Klebsiella Infections - mortality; Klebsiella pneumoniae - classification; Klebsiella pneumoniae - drug effects; Klebsiella pneumoniae - genetics; KPC; Male; Mcr-1; Microbial Sensitivity Tests; Molecular Epidemiology; Molecular Typing; NDM; PFGE; Resistance epidemiology; Tigecycline - pharmacology
• ISSN: 0732-8893; 1879-0070
• DOI: 10.1016/j.diagmicrobio.2018.06.001

A matched 1:2 case–control study was conducted among critically ill patients in order to identify the risk factors of colistin or tigecycline-resistant carbapenemase-producing Klebsiella pneumoniae (ColR-Kp, TigR-Kp) bacteraemia. MIC to colistin and tigecycline were determined by Etest. From 224 bacteraemic patients, 46.4% and 29.5% were resistant to colistin and tigecycline, respectively. PCR revealed that 199 isolates carried the blaKPC gene. PCR revealed that no isolate carried the mcr-1 gene. Risk factors for ColR-Kp bacteraemia as compared to patients with bacteraemia by a colistin-susceptible isolate or patients without carbapenemase-producing K. pneumoniae bacteraemia were colistin or tigecycline administration and tracheostomy, while TigR-Kp bacteraemia as compared to either patients with bacteraemia by tigecycline-susceptible isolate or patients without carbapenemase-producing K. pneumoniae bacteraemia were colistin or tigecycline administration, number of comorbidities and prior bacteraemia by a Gram-negative pathogen. Administration of colistin and tigecycline predisposed to development of bacteraemia by either ColR-Kp or TigR-Kp. •Colistin resistance among bacteraemic K. pneumoniae isolates was 46.4%.•Tigecycline resistance among bacteraemic K. pneumoniae isolates was 29.5%.•Most isolates were blaKPC positive. No isolate carried mcr-1 gene.•Colistin or tigecycline administration predisposed to bacteraemia by such isolates.•Mortality wasn't influenced by either colistin or tigecycline resistance.