Manesh Abi, Shankar Chaitra, George Mithun M, Jasrotia Davinder S, Lal Binesh, George Biju, Mathews Vikram, Eapen C E, Joseph Philip, Subramani K, Rao Shoma, Peter John V, Chacko Binila, Zachariah Anand, Sathyendra Sowmya, Hansdak Samuel G, Abraham Ooriapadickal C, Iyadurai Ramya, Vijayakumar Saranya, Karthik Rajiv, Marwick Charis A, Parcell Benjamin J, Gilbert Ian H, Veeraraghavan Balaji, Varghese George M
Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, 632004, India.
Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, 632004, India.
Infect Dis Ther. 2023 May;12(5):1319-1335. doi: 10.1007/s40121-023-00803-3. Epub 2023 Apr 16.
The objective of this study was to examine the evolution of carbapenem-resistant Klebsiella pneumoniae (CRKp) infections and their impact at a tertiary care hospital in South India.
A comparative analysis of clinical data from two prospective cohorts of patients with CRKp bacteremia (C1, 2014-2015; C2, 2021-2022) was carried out. Antimicrobial susceptibilities and whole genome sequencing (WGS) data of selected isolates were also analyzed.
A total of 181 patients were enrolled in the study, 56 from C1 and 125 from C2. CRKp bacteremia shifted from critically ill patients with neutropenia to others (ICU stay: C1, 73%; C2, 54%; p = 0.02). The overall mortality rate was 50% and the introduction of ceftazidime-avibactam did not change mortality significantly (54% versus 48%; p = 0.49). Oxacillinases (OXA) 232 and 181 were the most common mechanisms of resistance. WGS showed the introduction of New Delhi metallo-β-lactamase-5 (NDM-5), higher genetic diversity, accessory genome content, and plasmid burden, as well as increased convergence of hypervirulence and carbapenem resistance in C2.
CRKp continues to pose a significant clinical threat, despite the introduction of new antibiotics. The study highlights the evolution of resistance and virulence in this pathogen and the impact on patient outcomes in South India, providing valuable information for clinicians and researchers.
本研究的目的是调查耐碳青霉烯类肺炎克雷伯菌（CRKp）感染的演变情况及其在印度南部一家三级护理医院中的影响。
对两组CRKp菌血症患者的前瞻性队列（C1组，2014 - 2015年；C2组，2021 - 2022年）的临床数据进行了比较分析。还分析了所选分离株的抗菌药敏性和全基因组测序（WGS）数据。
共有181名患者纳入本研究，其中C1组56名，C2组125名。CRKp菌血症患者从患有中性粒细胞减少症的重症患者转变为其他患者（入住重症监护病房情况：C1组为73%，C2组为54%；p = 0.02）。总体死亡率为50%，头孢他啶 - 阿维巴坦的使用并未显著改变死亡率（54%对48%；p = 0.49）。奥沙西林酶（OXA）232和181是最常见的耐药机制。WGS显示C2组中出现了新德里金属β - 内酰胺酶 - 5（NDM - 5），遗传多样性、辅助基因组含量和质粒负荷增加，以及高毒力和碳青霉烯耐药性的趋同增加。
尽管引入了新的抗生素，但CRKp仍然构成重大的临床威胁。该研究突出了这种病原体耐药性和毒力的演变以及对印度南部患者结局的影响，为临床医生和研究人员提供了有价值的信息。
