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
Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, University of Patras, 26504, Rion-Patras, Greece.
Department of Microbiology, School of Medicine, University of Patras, 26504, Rion-Patras, Greece.
Diagn Microbiol Infect Dis. 2018 Nov;92(3):235-240. doi: 10.1016/j.diagmicrobio.2018.06.001. Epub 2018 Jun 7.
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 bla 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.
为了确定耐黏菌素或替加环素的产碳青霉烯酶肺炎克雷伯菌（ColR-Kp、TigR-Kp）菌血症的危险因素，在重症患者中开展了一项1:2配对病例对照研究。采用Etest法测定对黏菌素和替加环素的最低抑菌浓度（MIC）。在224例菌血症患者中，分别有46.4%和29.5%对黏菌素和替加环素耐药。聚合酶链反应（PCR）显示199株分离菌携带bla基因。PCR显示没有分离菌携带mcr-1基因。与由对黏菌素敏感的分离菌引起菌血症的患者或无产碳青霉烯酶肺炎克雷伯菌菌血症的患者相比，ColR-Kp菌血症的危险因素是使用黏菌素或替加环素以及气管切开术；而与由对替加环素敏感的分离菌引起菌血症的患者或无产碳青霉烯酶肺炎克雷伯菌菌血症的患者相比，TigR-Kp菌血症的危险因素是使用黏菌素或替加环素、合并症数量以及既往革兰阴性病原体菌血症。使用黏菌素和替加环素易导致ColR-Kp或TigR-Kp菌血症的发生。
