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Volume 48, Number 2, April 2015

Clinical features of patients with carbapenem nonsusceptible Klebsiella pneumoniae and Escherichia coli in intensive care units: A nationwide multicenter study in Taiwan 


Yea-Yuan Chang, Yin-Ching Chuang, L. Kristopher Siu, Tsu-Lan Wu, Jung-Chung Lin, Po-Liang Lu, Jann-Tay Wang, Lih-Shinn Wang, Yi-Tsung Lin, Ling-Ju Huang, Chang-Phone Fung


Received: January 16, 2014    Revised: May 1, 2014    Accepted: May 19, 2014   

 

Corresponding author:

Yi-Tsung Lin
Corresponding author. Division of Infectious Disease, Department of Medicine, Taipei Veterans General Hospital, Number 201, Section 2, Shih-Pai Road, 112 Taipei, Taiwan. 



 

Background and purpose: 

Patients in intensive care units (ICUs) are especially prone to colonization and infection by carbapenem-resistant Enterobacteriaceae. We conducted a multicenter investigation to study the clinical and microbiological characteristics of patients with carbapenem nonsusceptible Klebsiella pneumoniae and Escherichia coli in ICUs of Taiwanese hospitals. 



 

Methods:

Patients with carbapenem nonsusceptible K. pneumoniae and E. coli in ICUs from nine medical centers and eight regional hospitals in Taiwan were enrolled in 2012. Carbapenem nonsusceptibility was defined as a minimum inhibitory concentration of at least 2 mg/L for imipenem or meropenem. Clinical characteristics and risk factors for 30-day mortality were analyzed. Isolates were screened for antibiotic susceptibility and β-lactamase genes. 



 

Results:

A total of 66 cases infected (n = 46) or colonized (n = 20) with carbapenem nonsusceptible K. pneumoniae (n = 60) and E. coli (n = 6) were identified during the study period. Nineteen isolates had genes that encoded carbapenemases (28.8%), including Klebsiella pneumoniae carbapenemase-2 (KPC-2) (n = 14), imipenemase-8 (IMP-8) (n = 1), Verona integron-encoded metallo-β-lactamase (VIM) (n = 3), and New Delhi metallo-β-lactamase-1 (NDM-1) (n = 1). The in-hospital mortality associated with non-susceptible K. pneumoniae and E. coli was 50%. The 30-day mortality of the 46 patients with infection was 50%. Septic shock was the only independent risk factor for 30-day mortality in patients with infection. The 30-day mortality rate was similar between patients with combination therapy and monotherapy. 



 

Conclusion:

Patients who acquired carbapenem nonsusceptible K. pneumoniae and E. coli in ICUs have a high mortality rate. Further clinical study is needed to deal with this emerging challenge. 



 

Key words:

Carbapenem, Escherichia coli, Intensive care unit, Klebsiella pneumoniae