Skip to main content
SpringerLink
Log in

Molecular Epidemiology and Risk Factors of Carbapenem-Resistant Klebsiella Pneumoniae Bloodstream Infections in Wuhan, China

  • Published:
Current Medical Science Aims and scope Submit manuscript

Abstract

Objective

The clinical characteristics and microbiological data of patients with K. pneumoniae bloodstream infections (BSI) from January 2018 to December 2020 were retrospectively analyzed to study the molecular epidemiology of Carbapenem-resistant Klebsiella pneumoniae (CRKP). We also aimed to identify the risk factors for the development of CRKP BSI.

Methods

This retrospective study was conducted at Renmin Hospital of Wuhan University from January 2018 to December 2020. The date of non-duplicate K. pneumoniae isolates isolated from blood samples was identified using the microbiology laboratory database. The data from patients diagnosed with K. pneumoniae BSI were collected and analyzed.

Results

From 2018 to 2020, there were 510 non-duplicated K. pneumoniae blood isolates, mainly distributed in the intensive care unit (ICU) (28.4%), that were identified in our research. These cases included 77 strains of CRKP and 433 strains of carbapenem-susceptible K. pneumoniae (CSKP). The resistance rate of K. pneumoniae to meropenem and imipenem increased from 11.2% in 2018 to 27.1% in 2020. Moreover, Compared with CSKP, all CRKP isolates showed multi-resistance to tested antibiotics. The phylogenetic analysis showed that the CRKP isolates could be grouped into four major clades, and multilocus sequence typing revealed that the isolates had considerable clonality. Overall, 8 sequence types (STs) of CRKP were detected, of which ST11 comprised the majority and clustered into clade 3. The most prevalent carbapenemase gene was blaKPC (87%) among the CRKP isolates, followed by blaNDM (9.1%) and blaIMP (1.3%). A total of 74 (16.6%) patients with CRKP BSI and 373 (83.4%) patients with CSKP BSI were categorized as the case and control groups. The mortality in the CRKP group was 44.6%, and 11.5% in CSKP group (P<0.001). A multivariate analysis that a long hospital stay before BSI (OR=1.42, 95% CI 1.02–4.31, P=0.011), ICU hospitalization history (OR=3.30, 95% CI 1.35–8.05, P=0.002), and prior use of carbapenems (OR=3.33, 95% CI 1.29–7.27, P=0.001) and antifungals (OR=2.81, 95% CI 1.24–6.04, P<0.001) were independent risk factors for CRKP BSI.

Conclusion

ST11 is the predominant type of CRKP mediating inter-hospital transmission, and blaKPC is the main carbapenemase gene harboured by CRKP blood isolates. ICU stay, prolonged hospitalization before BSI, and prior use of carbapenems and antifungals were independent risk factors for acquiring CRKP BSI. Our study may provide insights into early infection control practices.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Pitout JD, Nordmann P, Poirel L. Carbapenemase-Producing Klebsiella pneumoniae, a Key Pathogen Set for Global Nosocomial Dominance. Antimicrob Agents Chemother, 2015,59(10):5873–5884

    Article  CAS  Google Scholar 

  2. Russo TA, Marr MC. hypervirulent Klebsiella pneumoniae. Clin Microbiol Rev, 2019, 32(3): e0001–19

    Article  Google Scholar 

  3. Munoz-Price LS, Poirel L, Bonomo RA, et al. Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases. Lancet Infect Dis, 2013, 13(9):785–796

    Article  Google Scholar 

  4. Girometti N, Lewis RE, Giannella M, et al. Klebsiella pneumoniae bloodstream infection: epidemiology and impact of inappropriate empirical therapy. Medicine (Baltimore), 2014,93(17):298–309

    Article  CAS  Google Scholar 

  5. Yang Y, Chen J, Lin D, et al. Prevalence and drug resistance characteristics of carbapenem-resistant Enterobacteriaceae in Hangzhou, China. Front Med, 2018,12(2):182–188

    Article  Google Scholar 

  6. Xu LF, Sun XX, Ma XL. Systematic review and meta-analysis of mortality of patients infected with carbapenem-resistant Klebsiella pneumoniae. Ann Clin Microbiol Antimicrob, 2017,16(1):18

    Article  Google Scholar 

  7. Suay-Garcia B, Perez-Gracia MT. Present and Future of Carbapenem-resistant Enterobacteriaceae (CRE) Infections. Antibiotics (Basel), 2019,8(3):122

    Article  CAS  Google Scholar 

  8. Jeon JH, Lee JH, Lee JJ, et al. Structural basis for carbapenem-hydrolyzing mechanisms of carbapenemases conferring antibiotic resistance. Int J Mol Sci, 2015, 16(5):9654–9692

    Article  CAS  Google Scholar 

  9. Iredell J, Brown J, Tagg K. Antibiotic resistance in Enterobacteriaceae: mechanisms and clinical implications. BMJ, 2016,352:h6420

    Article  Google Scholar 

  10. Kopotsa K, Sekyere JO, Mbelle NM. Plasmid evolution in carbapenemase-producing Enterobacteriaceae: a review. Ann N Y Acad Sci, 2019,1457(1):61–91

    Article  CAS  Google Scholar 

  11. Mohamed ER, Ali MY, Waly NGFM, et al. The Inc FII Plasmid and its Contribution in the Transmission of blaNDM-1 and blaKPC-2 in Klebsiella pneumoniae in Egypt. Antibiotics (Basel), 2019,8(4):266

    Article  CAS  Google Scholar 

  12. Lee CR, Lee JH, Park KS, et al. Global Dissemination of Carbapenemase-Producing Klebsiella pneumoniae: Epidemiology, Genetic Context, Treatment Options, and Detection Methods. Front Microbiol, 2016,7:895

    PubMed  PubMed Central  Google Scholar 

  13. Chen L, Mathema B, Chavda KD, et al. Carbapenemase-producing Klebsiella pneumoniae: molecular and genetic decoding. Trends Microbiol, 2014,22(12):686–696

    Article  CAS  Google Scholar 

  14. Diancourt L, Passet V, Verhoef J, et al. Multilocus sequence typing of Klebsiella pneumoniae nosocomial isolates. J Clin Microbiol, 2005,43(8):4178–4182

    Article  CAS  Google Scholar 

  15. Shao CH, Wang W, Liu S, et al. Molecular Epidemiology and Drug Resistant Mechanism of Carbapenem-Resistant Klebsiella pneumoniae in Elderly Patients With Lower Respiratory Tract Infection. Front Public Health, 2021,9:669173

    Article  Google Scholar 

  16. Tian LJ, Tan RM, Chen Y, et al. Epidemiology of bloodstream infections in a teaching hospital: factors related to the carbapenem resistance and patient mortality. Antimicrob Resist Infect Control, 2016,5:48

    Article  Google Scholar 

  17. Li YY, Li JH, Hu T, 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):79

    Article  Google Scholar 

  18. Zhang SG, Yang ZY, Sun LM, et al. Clinical Observation and Prognostic Analysis of Patients With Klebsiella pneumoniae Bloodstream Infection. Front Cell Infect Microbiol, 2020,10:577244

    Article  CAS  Google Scholar 

  19. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control, 2008,36(5):309–332

    Article  Google Scholar 

  20. Probst K, Boutin S, Bandilla M, et al. Fast and automated detection of common carbapenemase genes using multiplex real-time PCR on the BD MAX™ system. J Microbiol Methods, 2021,185:106224

    Article  CAS  Google Scholar 

  21. Diancourt L, Psaaet V, Verhoef J, et al. Multilocus sequence typing of Klebsiella pneumoniae nosocomial isolates. J Clin Microbiol, 2005,43(8):4178–4182

    Article  CAS  Google Scholar 

  22. Rose DD, Sordillo P, Gini S, et al. Microbiologic characteristics and predictors of mortality in bloodstream infections in intensive care unit patients: A 1-year, large, prospective surveillance study in 5 Italian hospitals. Am J Infect Control, 2015,43(11):1178–1183

    Article  Google Scholar 

  23. Hu YM, Ping YT, Li LQ, et al. A retrospective study of risk factors for carbapenem-resistant Klebsiella pneumoniae acquisition among ICU patients. J Infect Dev Ctries, 2016,10(3):208–213

    Article  CAS  Google Scholar 

  24. Zhang Y, Guo LY, Song WQ, et al. Risk factors for carbapenem-resistant K. pneumoniae bloodstream infection and predictors of mortality in Chinese paediatric patients. BMC Infect Dis, 2018,18(1):248

    Article  CAS  Google Scholar 

  25. Zheng X, Wang JF, Xu WL, et al. Clinical and molecular characteristics, risk factors and outcomes of Carbapenem-resistant bloodstream infections in the intensive care unit. Antimicrob Resist Infect Control, 2017,6:102

    Article  Google Scholar 

  26. Zhang SG, Yang ZY, Sun LM, et al. Clinical Observation and Prognostic Analysis of Patients With Klebsiella pneumoniae Bloodstream Infection. Front Cell Infect Microbiol, 2020,10:577244

    Article  CAS  Google Scholar 

  27. Viale P, Giannella M, Lewis R, et al. Predictors of mortality in multidrug-resistant Klebsiella pneumoniae bloodstream infections. Expert Rev Anti Infect Ther, 2013,11(10): 1053–1063

    Article  CAS  Google Scholar 

  28. Jiao Y, Qin YH, Liu JJ, et al. Risk factors for carbapenem-resistant Klebsiella pneumoniae infection/colonization and predictors of mortality: a retrospective study. Pathog Glob Health, 2015,109(2):68–74

    Article  CAS  Google Scholar 

  29. Karam G, Chastre J, Wilcox MH, et al. Antibiotic strategies in the era of multidrug resistance. Crit Care, 2016,20(1):136

    Article  Google Scholar 

  30. Gorrie CL, Mirceta M, Wick RR, et al. Gastrointestinal Carriage Is a Major Reservoir of Klebsiella pneumoniae Infection in Intensive Care Patients. Clin Infect Dis, 2017,65(2): 208–215

    Article  CAS  Google Scholar 

  31. Gao H, Liu YD, Wang RB, et al. The transferability and evolution of NDM-1 and KPC-2 co-producing Klebsiella pneumoniae from clinical settings. EBioMedicine, 2020,51:102599

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, China

    Chan Liu, Lan Liu, Ming-ming Jin, Lu Wan, Hai-yue Zhang, Rui-yun Li & Xiao-jun Wu

  2. State Key Laboratory of Virology, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, 430060, China

    Yang-bo Hu

  3. Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, 430060, China

    Xuan Cai

Authors
  1. Chan Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lan Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ming-ming Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yang-bo Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xuan Cai
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lu Wan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hai-yue Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rui-yun Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Xiao-jun Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xiao-jun Wu.

Ethics declarations

The authors declare that there are no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liu, C., Liu, L., Jin, Mm. et al. Molecular Epidemiology and Risk Factors of Carbapenem-Resistant Klebsiella Pneumoniae Bloodstream Infections in Wuhan, China. CURR MED SCI 42, 68–76 (2022). https://doi.org/10.1007/s11596-021-2480-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11596-021-2480-5

Key words

Search

Navigation