Background: During the last decade, the spread of Klebsiella pneumoniae-carbapenemase-pro-ducing Klebsiella pneumoniae (KPC-Kp) has increased dramatically worldwide. In this scenario, growing interest has been addressed to genotyping of KPC-Kp strains, which emerged as an important tool for a better understanding of the epidemiological and clinical characteristics of the outbreaks. Methods: We performed a retrospective cohort study on patients infected with KPC-Kp during a 28-month outbreak period (January 2010–April 2012) at San Gerardo Hospital (Monza, Italy), in-vestigating KPC-Kp genotypes by means of repetitive element sequence-based polymerase chain reaction (Rep-PCR). Results: We enrolled 97 patients infected with KPC-Kp. Rep-PCR analysis identified 5 distinct clone types, with different distribution over time. During the first 12 months of the outbreak pe-riod, only 1 clone was detected (clone A, in 47 patients), while the 4 other clones were identified over the remaining 16 months (clones C, E, and F/L in 23, 24, and 3 patients respectively). Me-chanical ventilation was less frequent in patients infected with clones C/E/F/L (OR = 0.14; 95% CI: 0.05-0.37) compared to clone A, and the Charlson comorbidity index (CI) was more likely to have a score >5 in patients infected with clones C/E/F/L (OR = 7.21; 95% CI: 2.24-23.14) compared to clone A. Overall mortality was higher in patients infected with clones C/E/F/L (13/20 patients, 65%) compared to those infected with clone A (7/20, 35%). Mortality in patients infected with clones C/E/F/L remained significantly higher even after adjusting for the potential confounding effect of comorbidities (ie, CI), with a hazard ratio (HR) of 4.65 (95% CI: 1.83-11.89). Conclusions: Our results suggested a close relationship between strain genotype and clinical outcome.

Clinical usefulness of klebsiella pneumoniae carbapenemase-producing k. Pneumoniae genotyping: The experience of a single-center epidemic / M. Rossi, L. Chatenoud, E.F. Vigano, A.M. Peri, L. Alagna, S. Bramati, M. Manenti, M. Raggi, A. Cavallero, L. Bisi, S. Leone, G.M. Migliorino, A. Bandera, A. Gori. - In: PATHOGENS & IMMUNITY. - ISSN 2469-2964. - 1:2(2016), pp. 352-370. [10.20411/pai.v1i2.109]

Clinical usefulness of klebsiella pneumoniae carbapenemase-producing k. Pneumoniae genotyping: The experience of a single-center epidemic

Chatenoud L.;Peri A. M.;Bandera A.;Gori A.
2016

Abstract

Background: During the last decade, the spread of Klebsiella pneumoniae-carbapenemase-pro-ducing Klebsiella pneumoniae (KPC-Kp) has increased dramatically worldwide. In this scenario, growing interest has been addressed to genotyping of KPC-Kp strains, which emerged as an important tool for a better understanding of the epidemiological and clinical characteristics of the outbreaks. Methods: We performed a retrospective cohort study on patients infected with KPC-Kp during a 28-month outbreak period (January 2010–April 2012) at San Gerardo Hospital (Monza, Italy), in-vestigating KPC-Kp genotypes by means of repetitive element sequence-based polymerase chain reaction (Rep-PCR). Results: We enrolled 97 patients infected with KPC-Kp. Rep-PCR analysis identified 5 distinct clone types, with different distribution over time. During the first 12 months of the outbreak pe-riod, only 1 clone was detected (clone A, in 47 patients), while the 4 other clones were identified over the remaining 16 months (clones C, E, and F/L in 23, 24, and 3 patients respectively). Me-chanical ventilation was less frequent in patients infected with clones C/E/F/L (OR = 0.14; 95% CI: 0.05-0.37) compared to clone A, and the Charlson comorbidity index (CI) was more likely to have a score >5 in patients infected with clones C/E/F/L (OR = 7.21; 95% CI: 2.24-23.14) compared to clone A. Overall mortality was higher in patients infected with clones C/E/F/L (13/20 patients, 65%) compared to those infected with clone A (7/20, 35%). Mortality in patients infected with clones C/E/F/L remained significantly higher even after adjusting for the potential confounding effect of comorbidities (ie, CI), with a hazard ratio (HR) of 4.65 (95% CI: 1.83-11.89). Conclusions: Our results suggested a close relationship between strain genotype and clinical outcome.
Carbapenemases; Drug-resistant; Enterobacteriaceae; Genotyping profiles; KPC-Kp
Settore MED/17 - Malattie Infettive
Article (author)
File in questo prodotto:
File Dimensione Formato  
document (1).pdf

accesso aperto

Tipologia: Publisher's version/PDF
Dimensione 1.92 MB
Formato Adobe PDF
1.92 MB Adobe PDF Visualizza/Apri
Pubblicazioni consigliate

Caricamento pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/899818
Citazioni
  • ???jsp.display-item.citation.pmc??? 0
  • Scopus 0
  • ???jsp.display-item.citation.isi??? ND
social impact