Τίτλος:
The clinical significance of carbapenem-resistant Klebsiella pneumoniae
rectal colonization in critically ill patients: from colonization to
bloodstream infection
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Purpose. To highlight the clinical significance of carbapenem-resistant
Klebsiella pneumoniae (CRKP) rectal colonization by examining the risk
factors for CRKP rectal colonization and subsequent bloodstream
infection (BSI) in critically ill patients.
Methodology. Prospective study of CRKP rectal colonization in an
intensive care unit (ICU) during a 39-month period. CRKP strains
isolated from both the blood cultures and corresponding rectal specimens
(n=96) of patients were screened by PCR for the presence of antibiotic
resistance-associated genes. Molecular analyses were conducted to
investigate the clonal relatedness of CRKP strains from the rectal and
blood specimens.
Results. Among the 498 patients. 226 were rectally colonized by CRKP, 48
of whom developed a CRKP BSI. The median time from hospital admission to
the detection of CRKP rectal colonization was 8 days, while the median
time from colonization to BSI was 4 days. The duration of ICU stay,
patient/nurse ratio and prior use of antianaerobic antimicrobials were
associated with CRKP rectal colonization. No specific factor was
associated with BSIs in the colonized patients. The bla(KPC-2) gene was
detected in all 96 strains, which were all classified as sequence type
ST-258. Representative pairs (n=48) of CRKP strains colonizing and
infecting the same patient shared the same pulsotype.
Conclusion. Our results indicate that hospitalized patients become
infected with their colonizing strains, supporting the strong
association between colonization and BSI. Limiting antianaerobic
antimicrobial administration, reducing the duration of ICU stay and
maintaining a low patient/nurse ratio are possible strategies to
restrict rectal CRKP colonization in ICUs.
Συγγραφείς:
Kontopoulou, Konstantina
Iosifidis, Elias
Antoniadou, Eleni and
Tasioudis, Polychronis
Petinaki, Efthymia
Malli, Ergina and
Metallidis, Symeon
Vatopoulos, Alkiviadis
Malisiovas, Nicolaos
Περιοδικό:
Journal of Medical Microbiology
Εκδότης:
AMER SOC MICROBIOLOGY
Λέξεις-κλειδιά:
Carbapenem-resistant Klebsiella pneumoniae; colonization; bloodstream
infections; risk factors; intensive care unit
DOI:
10.1099/jmm.0.000921
