印度尼西亚雅加达国家转诊医院重症监护病房中地方性 NDM 产克雷伯菌的临床影响。
Clinical impact of endemic NDM-producing Klebsiella pneumoniae in intensive care units of the national referral hospital in Jakarta, Indonesia.
机构信息
Department of Clinical Microbiology, Faculty of Medicine, Universitas Indonesia / Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands.
出版信息
Antimicrob Resist Infect Control. 2020 May 11;9(1):61. doi: 10.1186/s13756-020-00716-7.
OBJECTIVE
A prospective observational study was performed to assess the epidemiology and clinical impact of carbapenem-non-susceptible Klebsiella pneumoniae (CNKP) in intensive care units (ICUs) of the national referral hospital in Jakarta, Indonesia.
MATERIALS/METHODS: Adult patients consecutively hospitalized for > 48 h in two ICUs of the national referral hospital were included from April until October 2013 and from April until August 2014. K. pneumoniae from clinical cultures and standardized screening of rectum and throat on admission, discharge and weekly if hospitalized > 7 days were collected. Environmental niches and healthcare workers (HCWs) were also screened. Susceptibility was determined phenotypically and the presence of carbapenemase genes by PCR. Raman spectroscopy as well as multiple-locus variable number tandem repeat analysis (MLVA) were used for typing.
RESULTS
Twenty-two out of 412 (5.3%) patients carried CNKP on admission and 37/390 (9.5%) acquired CNKP during ICU stay. The acquisition rate was 24.7/1000 patient-days at risk. One out of 31 (3.2%) environmental isolates was a CNKP. None of the HCWs carried CNKP. Acquisition of CNKP was associated with longer ICU stay (adjusted Hazard Ratio: 2.32 [CI: 1.35-3.68]). ICU survival was lower among patients with CNKP compared to patients with carbapenem-susceptible K. pneumoniae (aHR 2.57, p = 0.005). Ninety-six of the 100 (96%) CNKP isolates carried a carbapenemase gene, predominantly bla. Raman typing revealed three major clusters among 48 Raman types identified, whereas MLVA distinguished six major clusters among a total of 30 different genotypes.
CONCLUSIONS
NDM-producing CNKP are introduced into these ICUs and some strains expand clonally among patients and the environment, resulting in endemic CNKP. CNKP acquisition was associated with prolonged ICU stay and may affect ICU survival.
TRIAL REGISTRATION
The study was registered at Netherlands Trial Register http://www.trialregister.nl. Candidate number: 23527, NTR number: NTR5541, NL number: NL5425 (https://www.trialregister.nl/trial/5424), Retrospectively registered: NTR: 22 December 2015.
目的
在印度尼西亚雅加达的国家转诊医院的两个重症监护病房（ICU）中进行了一项前瞻性观察研究，以评估耐碳青霉烯类肺炎克雷伯菌（CNKP）的流行病学和临床影响。
材料/方法：2013 年 4 月至 10 月和 2014 年 4 月至 8 月期间，连续入住 ICU 超过 48 小时的成年患者纳入研究。从临床培养物和入院时、出院时以及如果住院时间超过 7 天则每周一次的直肠和咽部的标准化筛查中收集肺炎克雷伯菌。还对环境小生境和医护人员（HCW）进行了筛查。通过表型和 PCR 检测碳青霉烯酶基因来确定药敏性。拉曼光谱和多位点可变数串联重复分析（MLVA）用于分型。
结果
22 例（5.3%）入院患者携带 CNKP，37 例（9.5%）患者在 ICU 期间获得 CNKP。每 1000 个患者风险日的获得率为 24.7 例。31 个环境分离株中只有 1 株为 CNKP。没有医护人员携带 CNKP。CNKP 的获得与 ICU 停留时间延长有关（调整后的危险比：2.32[95%CI：1.35-3.68]）。与耐碳青霉烯类肺炎克雷伯菌相比，携带 CNKP 的患者 ICU 生存率较低（调整后 HR 2.57，p=0.005）。100 例 CNKP 分离株中的 96 例（96%）携带碳青霉烯酶基因，主要为 bla.拉曼分型显示在鉴定的 48 种拉曼类型中存在三个主要聚类，而 MLVA 在总共 30 种不同基因型中区分了六个主要聚类。
结论
产 NDM 的耐碳青霉烯类肺炎克雷伯菌被引入这些 ICU，一些菌株在患者和环境中克隆扩增，导致耐碳青霉烯类肺炎克雷伯菌的流行。CNKP 的获得与 ICU 停留时间延长有关，并可能影响 ICU 生存率。
试验注册
该研究在荷兰试验注册中心进行登记，http://www.trialregister.nl。候选编号：23527，NTR 编号：NTR5541，NL 编号：NL5425（https://www.trialregister.nl/trial/5424），回顾性注册：NTR：2015 年 12 月 22 日。
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