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The role of colonization pressure in the dissemination of colistin or tigecycline resistant KPC-producing Klebsiella pneumoniae in critically ill patients

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Abstract

Purpose

To identify the risk factors for incident enteric colonization by KPC-producing Klebsiella pneumoniae (KPC-Kp) resistant to colistin or tigecycline during Intensive Care Unit (ICU) stay.

Method

A prospective observational study of patients admitted to the ICU was conducted during a 27-month period. Rectal samples taken upon admission and weekly afterwards were inoculated on selective chromogenic agar. K. pneumoniae isolates were characterized by standard methodology. Mean inhibitory concentration (MIC) to colistin and tigecycline were determined by E-test. The presence of bla KPC gene was confirmed by PCR.

Results

Among 254 patients, 62 (24.4 %) became colonized by colistin- resistant KPC-Kp during their stay. Multivariate analysis revealed that corticosteroid, colistin administration and number of colonized patients in nearby beds per day were significantly associated with colonization. Among 257 patients, 39 (17.9 %) became colonized by tigecycline resistant KPC-Kp during their stay. Risk factors identified by multivariate analysis were: days at risk, obesity, number of colonized patients treated in nearby beds per day and administration of tigecycline.

Conclusions

The high prevalence of colistin or tigecycline resistant KPC-Kp enteric carriage in ICU patients indicate that dissemination is due to their transfer from patient to patient via the personnel and indicates the importance of strict infection control protocols.

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References

  1. Maltezou HC, Giakkoupi P, Maragos A, et al. Outbreak of infections due to KPC-2-producing Klebsiella pneumoniae in a hospital in Crete (Greece). J Infect. 2009;58:213–9.

    Article  PubMed  CAS  Google Scholar 

  2. Papadimitriou-Olivgeris M, Marangos M, Fligou F, et al. KPC-producing Klebsiella pneumoniae enteric colonization acquired during intensive care unit stay: the significance of risk factors for its development and its impact on mortality. Diagn Microbiol Infect Dis. 2013;77:169–73.

    Article  PubMed  Google Scholar 

  3. Giakkoupi P, Papagiannitsis CC, Miriagou V, et al. An update of the evolving epidemic of blaKPC-2-carrying Klebsiella pneumoniae in Greece (2009–10). J Antimicrob Chemother. 2011;66:1510–3.

    Article  PubMed  CAS  Google Scholar 

  4. Giakoupi P, Maltezou H, Polemis M, et al. KPC-2-producing Klebsiella pneumoniae infections in Greek hospitals are mainly due to a hyperepidemic clone. Euro Surveill. 2009;14. pii:19218.

  5. Grundmann H, Livermore DM, Giske CG, et al. Carbapenem-non-susceptible Enterobacteriaceae in Europe: conclusions from a meeting of national experts. Euro Surveill. 2010;15. pii:19711.

  6. European Centre for Disease Prevention and Control (ECDC). Antimicrobial resistance surveillance in Europe 2012. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). Stockholm: ECDC; 2013.

  7. Kontopidou F, Giamarellou H, Katerelos P, et al. Infections caused by carbapenem-resistant Klebsiella pneumoniae among patients in intensive care units in Greece: a multi-centre study on clinical outcome and therapeutic options. Clin Microbiol Infect. 2014;20:O117–23. doi:10.1111/1469-0691.12341.

    Article  PubMed  CAS  Google Scholar 

  8. Tumbarello M, Viale P, Viscoli C, et al. Predictors of mortality in bloodstream infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae: importance of combination therapy. Clin Infect Dis. 2012;55:943–50.

    Article  PubMed  CAS  Google Scholar 

  9. Qureshi ZA, Paterson DL, Potoski BA, et al. Treatment outcome of bacteremia due to KPC-producing Klebsiella pneumoniae: superiority of combination antimicrobial regimens. Antimicrob Agents Chemother. 2012;56:2108–13.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  10. da Silva RM, Traebert J, Galato D. Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae: a review of epidemiological and clinical aspects. Expert Opin Biol Ther. 2012;12:663–71.

    Article  PubMed  Google Scholar 

  11. Markou N, Apostolakos H, Koumoudiou C, et al. Intravenous colistin in the treatment of sepsis from multiresistant Gram-negative bacilli in critically ill patients. Crit Care. 2003;7:R78–83.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Valentin-Martin A, Valverde-De Francisco A, Bosque-Vall M, et al. First report of colistin-resistant KPC-2 producing ST258-Klebsiella pneumoniae in Spain. Enferm Infect Microbiol Clin. 2013;31:489–91. doi:10.1016/j.eimc.2012.12.002.

    Article  Google Scholar 

  13. Kontopidou F, Plachouras D, Papadomichelakis E, et al. Colonization and infection by colistin-resistant Gram-negative bacteria in a cohort of critically ill patients. Clin Microbiol Infect. 2011;17:E9–11. doi:10.1111/j.1469-0691.2011.03649.x.

    Article  PubMed  CAS  Google Scholar 

  14. Nigo M, Cevallos CS, Woods K, et al. Nested case-control study of the emergence of tigecycline resistance in multidrug-resistant Klebsiella pneumoniae. Antimicrob Agents Chemother. 2013;57:5743–6.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  15. Clinical and Laboratory Standards Institute (CLSI). Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically, 12th edn. Approved standard M7-A7. Wayne: CLSI; 2011.

  16. The European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint tables for interpretation of MICs and zone diameters. Version 3.1; 2013. http://www.eucast.org. Accessed 24 Mar 2014.

  17. Tsakris A, Poulou A, Pournaras S, et al. A simple phenotypic method for the differentiation of metallo-b-lactamases and class A KPC carbapenemases in Enterobacteriaceae clinical isolates. J Antimicrob Chemother. 2010;65:1664–71.

    Article  PubMed  CAS  Google Scholar 

  18. Queenan AM, Bush K. Carbapenemases: the versatile beta-lactamases. Clin Microbiol Rev. 2007;20:440–58.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  19. Papadimitriou-Olivgeris M, Marangos M, Fligou F, et al. Risk factors for KPC-producing Klebsiella pneumoniae enteric colonization upon ICU admission. J Antimicrob Chemother. 2012;67:2976–81.

    Article  PubMed  CAS  Google Scholar 

  20. Lubbert C, Faucheux S, Becker-Rux D, et al. Rapid emergence of secondary resistance to gentamicin and colistin following selective digestive decontamination in patients with KPC-2-producing Klebsiella pneumoniae: a single-centre experience. Int J Antimicrob Agents. 2013;42:565–70. doi:10.1016/j.ijantimicag.2013.08.008.

    Article  PubMed  Google Scholar 

  21. Halaby T, al Naiemi N, Kluytmans J, et al. Emergence of colistin resistance in Enterobacteriaceae after the introduction of selective digestive tract decontamination in an intensive care unit. Antimicrob Agents Chemother. 2013;57:3224–9.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  22. Bonten MJ. Colonization pressure: a critical parameter in the epidemiology of antibiotic-resistant bacteria. Crit Care. 2012;16:142.

    PubMed  PubMed Central  Google Scholar 

  23. Nordmann P. Carbapenemase-producing Enterobacteriaceae: overview of a major public health challenge. Med Mal Infect. 2013;. doi:10.1016/j.medmal.2013.11.007.

    PubMed  Google Scholar 

  24. Tacconelli E, Cataldo MA, Dancer SJ, et al. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients. Clin Microbiol Infect. 2014;20(Suppl 1):1–55. doi:10.1111/1469-0691.12427.

    Article  PubMed  Google Scholar 

  25. North RJ. The action of cortisone acetate on cell-mediated immunity to infection. Suppression of host cell proliferation and alteration of cellular composition of infective foci. J Exp Med. 1971;134:1485–500.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  26. Moreira LL, Netto EM, Nascimento-Carvalho CM. Use of corticosteroid is a risk factor for nosocomial infection in paediatric patients. J Hosp Infect. 2009;71:287–8.

    Article  PubMed  CAS  Google Scholar 

  27. Genoni G, Prodam F, Marolda A, et al. Obesity and infection: two sides of one coin. Eur J Pediatr. 2014;173:25–32. doi:10.1007/s00431-013-2178-1.

    Article  PubMed  Google Scholar 

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Acknowledgments

A part of this work was presented as an oral presentation at the 23rd European Congress of Clinical Microbiology and Infectious Diseases, 27–30 April 2013, Berlin. There was no external financial support received in order to complete the present study and only institutional funds were used.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

The study was carried out under the permission of the University Hospital Ethical Committee (No: 571).

Author information

Authors and Affiliations

  1. Division of Infectious Diseases, Internal Medicine, School of Medicine, University of Patras, 26504, Rion-Patras, Greece

    M. Papadimitriou-Olivgeris & M. Marangos

  2. Department of Microbiology, School of Medicine, University of Patras, 26504, Rion-Patras, Greece

    M. Christofidou, C. Bartzavali & E. D. Anastassiou

  3. Anesthesiology and Critical Care Medicine, School of Medicine, University of Patras, 26504, Rion-Patras, Greece

    F. Fligou, T. Vrettos & K. S. Filos

Authors
  1. M. Papadimitriou-Olivgeris
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  2. M. Christofidou
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  3. F. Fligou
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  4. C. Bartzavali
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  5. T. Vrettos
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  6. K. S. Filos
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  7. M. Marangos
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  8. E. D. Anastassiou
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Corresponding author

Correspondence to E. D. Anastassiou.

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Papadimitriou-Olivgeris, M., Christofidou, M., Fligou, F. et al. The role of colonization pressure in the dissemination of colistin or tigecycline resistant KPC-producing Klebsiella pneumoniae in critically ill patients. Infection 42, 883–890 (2014). https://doi.org/10.1007/s15010-014-0653-x

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  • DOI: https://doi.org/10.1007/s15010-014-0653-x

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