Falcone Marco, Tiseo Giusy, Galfo Valentina, Giordano Cesira, Leonildi Alessandro, Marciano Emanuele, De Simone Paolo, Biancofiore Giandomenico, Boggi Ugo, Barnini Simona, Menichetti Francesco
Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Clin Microbiol Infect. 2022 Feb;28(2):298.e1-298.e7. doi: 10.1016/j.cmi.2021.06.031. Epub 2021 Jun 28.
To investigate the hypothesis that intestinal colonization by different types of carbapenemase-resistant Klebsiella pneumoniae (CR-Kp) leads to different risks for bloodstream infections (BSI) caused by the same colonizing organism.
Prospective observational study including consecutive CR-Kp rectal carriers admitted to the Pisa University Hospital (December 2018 to December 2019). Patients underwent rectal swabbing with molecular testing for the different carbapenemases at hospital admission and during hospitalization. Rectal carriers were classified as: NDM, KPC, VIM and OXA-48. The primary end point was the rate of BSI by the same colonizing organism in each study group. A multivariate logistic regression analysis was performed to identify factors independently associated with the risk for BSI by the colonizing organism.
Of 677 rectal carriers, 382/677 (56.4%) were colonized by NDM, 247/677 (36.5%) by KPC, 39/677 (5.8%) by VIM and 9/677 (1.3%) by OXA-48. Dissemination of NDM-Kp was mostly sustained by ST147, while KPC-Kp belonged to ST512. A higher rate of BSI was documented in NDM rectal carriers compared with KPC rectal carriers (59/382, 15.4% versus 20/247, 8.1%, p 0.004). Incidence rates of BSI per 100 patients/month were significantly higher in the NDM group (22.33, 95% CI 17.26-28.88) than in the KPC group (9.56, 95% CI 6.17-14.82). On multivariate analysis, multi-site extraintestinal colonization, solid organ transplantation, invasive procedures, intravascular device, admission to intensive care unit, cephalosporin, fluoroquinolones and NDM rectal colonization (OR 3.27, 95% CI 1.73-6.18, p < 0.001) were independently associated with BSI.
NDM-Kp was associated with increased risk of BSI compared with KPC-Kp. This finding seems to be strongly related to the high-risk clone ST147.
探讨不同类型耐碳青霉烯类肺炎克雷伯菌（CR-Kp）在肠道定植导致由同一定植菌引起血流感染（BSI）的风险不同这一假说。
前瞻性观察性研究，纳入2018年12月至2019年12月入住比萨大学医院的连续性CR-Kp直肠携带者。患者在入院时及住院期间接受直肠拭子检查，采用分子检测方法检测不同的碳青霉烯酶。直肠携带者分为：NDM型、KPC型、VIM型和OXA-48型。主要终点是各研究组中由同一定植菌引起的BSI发生率。进行多因素逻辑回归分析，以确定与定植菌引起BSI风险独立相关的因素。
在677例直肠携带者中，382/677（56.4%）为NDM型定植，247/677（36.5%）为KPC型定植，39/677（5.8%）为VIM型定植，9/677（1.3%）为OXA-48型定植。NDM-Kp的传播主要由ST147型菌株维持，而KPC-Kp属于ST512型。与KPC直肠携带者相比，NDM直肠携带者的BSI发生率更高（59/382，15.4%对20/247，8.1%，p=0.004）。NDM组每100例患者/月的BSI发病率（22.33，95%CI 17.26-28.88）显著高于KPC组（9.56，95%CI 6.17-14.82）。多因素分析显示，多部位肠外定植、实体器官移植、侵入性操作、血管内装置、入住重症监护病房、头孢菌素、氟喹诺酮类药物以及NDM直肠定植（OR 3.27，95%CI 1.73-6.18，p<0.001）与BSI独立相关。
与KPC-Kp相比，NDM-Kp与BSI风险增加相关。这一发现似乎与高危克隆株ST147密切相关。
