Papadimitriou-Olivgeris Matthaios, Bartzavali Christina, Karachalias Eleftherios, Spiliopoulou Anastasia, Tsiata Ekaterini, Siakallis Georgios, Assimakopoulos Stelios F, Kolonitsiou Fevronia, Marangos Markos
Division of Infectious Diseases, School of Medicine, University of Patras, 26504 Patras, Greece.
Infectious Diseases Service, Lausanne University Hospital, 1011 Lausanne, Switzerland.
Antibiotics (Basel). 2022 Oct 14;11(10):1414. doi: 10.3390/antibiotics11101414.
Background: Ceftazidime/avibactam (CZA) is a new option for the treatment of KPC-producing Klebsiella pneumoniae. The aim of this study was to determine resistance patterns and carbapenemase genes among K. pneumoniae (CP-Kp) bacteremic isolates before and after CZA introduction. Methods: K. pneumoniae from blood cultures of patients being treated in a Greek university hospital during 2015−21 were included. PCR for blaKPC, blaVIM, blaNDM and blaOXA-48 genes was performed. Results: Among 912 K. pneumoniae bacteremias: 725 (79.5%) were due to carbapenemase-producing isolates; 488 (67.3%) carried blaKPC; 108 (14.9%) blaVIM; 100 (13.8%) blaNDM; and 29 (4%) carried a combination of blaKPC, blaVIM or blaNDM. The incidence of CP-Kp bacteremias was 59 per 100,000 patient-days. The incidence of CP-Kp changed from a downward pre-CZA trend to an upward trend in the CZA period (p = 0.007). BSIs due to KPC-producing isolates showed a continuous downward trend in the pre-CZA and CZA periods (p = 0.067), while BSIs due to isolates carrying blaVIM or blaNDM changed from a downward trend in the pre-CZA to an upward trend in the CZA period (p < 0.001). Conclusions: An abrupt change in the epidemiology of CP-Kp was observed in 2018, due to the re-emergence of VIM-producing isolates after the suppression of KPC-producing ones via the use of CZA.
头孢他啶/阿维巴坦（CZA）是治疗产KPC肺炎克雷伯菌的一种新选择。本研究的目的是确定引入CZA前后肺炎克雷伯菌（CP-Kp）血流感染分离株的耐药模式和碳青霉烯酶基因。方法：纳入2015 - 2021年在希腊一家大学医院接受治疗的患者血培养中的肺炎克雷伯菌。对blaKPC、blaVIM、blaNDM和blaOXA - 48基因进行PCR检测。结果：在912例肺炎克雷伯菌血流感染中，725例（79.5%）是由产碳青霉烯酶的分离株引起；488例（67.3%）携带blaKPC；108例（14.9%）携带blaVIM；100例（13.8%）携带blaNDM；29例（4%）携带blaKPC、blaVIM或blaNDM的组合。CP-Kp血流感染的发生率为每10万患者日59例。CP-Kp的发生率从CZA引入前的下降趋势变为CZA时期的上升趋势（p = 0.007）。由产KPC分离株引起的血流感染在CZA引入前和CZA时期呈持续下降趋势（p = 0.067），而由携带blaVIM或blaNDM的分离株引起的血流感染从CZA引入前的下降趋势变为CZA时期的上升趋势（p < 0.001）。结论：2018年观察到CP-Kp的流行病学发生突然变化，这是由于通过使用CZA抑制产KPC分离株后，产VIM分离株重新出现。
