شیوع ایزوله های کلبسیلا پنومونیه مقاوم به کارباپنم و اثر فاکتورهای خطر دخیل در طول مدت بستری و مرگ ومیر
محورهای موضوعی : باکتری شناسی
1 - گروه زیست فناوری میکروبی، دانشکده زیست فناوری، دانشگاه تخصصی فناوری های نوین آمل، مازندران، ایران.
کلید واژه: کلبسیلا پنومونیه مقاوم به کارباپنم, مدت بیمارستانی شدن, بخش مراقبت های ویژه, مرگ ومیر ,
چکیده مقاله :
سابقه و هدف: ظهور کلبسیلا پنومونیه مقاوم به کارباپنم (CRKP) به عنوان یک تهدید جدی از سوی سازمان بهداشت جهانی معرفی شده است. هدف از این مطالعه، بررسی شیوع عفونت های کلبسیلا پنومونیه، الگوی مقاومت آنتی بیوتیکی و فاکتورهای خطر دخیل در مرگ و میر بیمارانCRKP می باشد.
مواد و روش ها: از بیماران بستری در ICU 200 نمونه عفونی جمع‌آوری شد و پس از شناسایی ایزوله های کلبسیلا پنومونیه و بررسی الگوی مقاومت آنتی بیوتیکی شان، با استفاده از مدل سازی رگرسیون خطی و لجستیک چند متغیره، اثراحتمالی چندین فاکتور خطر در طول مدت بستری و مرگ ومیر بیماران CRKP بررسی شد.
یافته ها: 124 نمونه (62 %) دارای باکتری کلبسیلا پنومونیه بودند. مقاومت آنتی بیوتیکی به کارباپنم ها (8/54 %)، سفالوسپورین ها (72%)، فلوروکینولون ها (7/87 %)، آمینوگلیکوزیدها (87%) و کلیستین (75%) به طور معناداری در بیماران CRKP بالاتر بود. نسبت ایزوله های مقاوم به چندین دارو (MDR) و تولید کننده بتالاکتاماز وسیع الطیف (ESBL) به ترتیب 7/67 % و 29% بودند. بیماری های زمینه ای (03/ 0 P=) و CRKP (01/0P=) دو فاکتور خطر مستقل دخیل در طول مدت بستری بودند. ارتباط معناداری میان سن بالا(04/ 0 P=) و مقاومت به کارباپنم (03/ 0 P=)، با مرگ و میر نیز وجود داشت.
نتیجه گیری: با توجه به ارتباط نرخ مقاومت بالای کارباپنم با طول مدت بستری و مرگ ومیر ، لزوم نظارت بر الگوی مقاومت میکروبی، و تجویز آنتی بیوتیک های ترکیبی جدید، می تواند در تسریع روند بهبودی و کاهش طول مدت بستری موثر باشد.
Background & Objectives: The emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) infections has been identified as a serious threat. This study aimed to investigate the prevalence of K. pneumoniae infections, antibiotic resistance patterns, and risk factors involved in increased mortality among patients with CRKP infection.
Material and methods: 200 infectious samples were collected from ICU patients. After identifying Klebsiella pneumoniae isolates and examining their antibiotic resistance patterns, the effect of several possible risk factors on hospitalization duration and mortality was investigated using linear regression and a multivariate logistic regression model.
Results: One hundred and twenty-four samples (62%) contained K. pneumoniae isolates. The resistance to carbapenems (54.8%), cephalosporins (72%), fluoroquinolones (87.7%), aminoglycosides (87%), and colistin (75%) was significantly higher among CRKP patients than those susceptible to carbapenem. The proportions of multidrug-resistant (MDR) and extended-spectrum beta-lactamase (ESBL)-producing isolates were 67.7% and 29%, respectively. Underlying diseases (P= 0.03) and resistance to carbapenem (P=0.001) were two independent risk factors associated with the duration of hospitalization. Additionally, there was a significant association between older age (P=0.04) and resistance to carbapenem (P=0.03) with mortality.
Conclusions: Given the high rate of CRKP, its association to length of hospital stays and patient mortality, and the increase in multidrug-resistant isolates, the need for monitoring of microbial resistance patterns and the prescription of new combination antibiotic regimens could be effective in improving the recovery process and reducing the duration of hospital stays of patients.
. 1 Lin X-c, Li C-l, Zhang S-y, Yang X-f, Jiang M. The global and regional prevalence of hospital-acquired carbapenem-resistant Klebsiella pneumoniae infection: a systematic review and meta-analysis. Open forum infectious diseases; 2024: Oxford University Press US. https://doi.org/10.1093/ofid/ofad649.
2. Qin X, Wu S, Hao M, Zhu J, Ding B, Yang Y, Xu X, Wang M, Yang F, Hu F. The colonization of carbapenem-resistant Klebsiella pneumoniae: epidemiology, resistance mechanisms, and risk factors in patients admitted to intensive care units in China. The Journal of infectious diseases. 2020;221(Supplement_2):S206-S14. https://doi.org/10.1093/infdis/jiz622.
3. Wu C, Zheng L, Yao J. Analysis of risk factors and mortality of patients with carbapenem-resistant Klebsiella pneumoniae infection. Infection and Drug Resistance. 2022:2383-91. https://doi.org/10.2147/idr.s362723
4. Sohrabi S, Kargar M, Ramezani A, Moazamian E, Ebrahiminejad A. Effect of particle size on the antimicrobial power of zinc oxide micro- and nano- particles in the powder form. Journal of Microbial World. 2025;17(61). [in persion].
5. . Alizadeh F, Mahmoudi H, Khodavandi A, Rahimi Foroudi M, Phishgar E. Presence pattern of genes related to ergosterol biosynthesis in colonizing Candida albicans isolates from patients with multiple sclerosis. Journal of Microbial World. 2025;17(61). [in persion].
. 6 Hawkey J, Wyres KL, Judd LM, Harshegyi T, Blakeway L, Wick R, Jenney A, Holt K. ESBL plasmids in Klebsiella pneumoniae: diversity, transmission and contribution to infection burden in the hospital setting. Genome medicine. 2022;14(1):97. https://doi.org/10.1186/s13073-022-01103-0.
7. Mirzaei B. Evaluation of Antibiotic Sensitivity, Biofilm Formation Ability, and Prevalence of Extended-Spectrum Beta-Lactamase (ESBLs) in Clinically Isolates Escherichia coli and Klebsiella pneumoniae. Journal of Advances in Medical and Biomedical Research. 2024;32(152):219-25. https://doi.org/10.61186/jambr.32.152.219
8. Vincent J-L, Sakr Y, Singer M, Martin-Loeches I. Prevalence and outcomes of infection among patients in intensive care units in 2017. Jama. 2020;323(15):1478-87
9. Cortegiani A, Antonelli M, Falcone M, Giarratano A, Girardis M, Leone M, Pea F, Stefani F, Viaggi B, Viale P. Rationale and clinical application of antimicrobial stewardship principles in the intensive care unit: a multidisciplinary statement. Journal of Anesthesia, Analgesia and Critical Care. 2023;3(1):11. https://doi.org/10.1186/s44158-023-00095-6
10. Liu W, Lin D, Wu N. Analysis of the Prevalence, Drug Resistance Genes and Evolution of Carbapenem-Resistant Klebsiella pneumoniae in Lishui, China from 2015 to 2024. Jundishapur Journal of Microbiology.18 (2). https://doi.org/10.5812/jjm-157871
11. Gupta N, Limbago BM, Patel JB, Kallen AJ. Carbapenem-resistant Enterobacteriaceae: epidemiology and prevention. Clinical infectious diseases. 2011;53(1):60-7. https://doi.org/10.1093/cid/cir202
12. Qureshi ZA, Paterson DL, Potoski BA, Kilayko MC, Sandovsky G, Sordillo E, Polsky B, Adams J, Doi Y. Treatment outcome of bacteremia due to KPC-producing Klebsiella pneumoniae: superiority of combination antimicrobial regimens. Antimicrobial agents and chemotherapy. 2012;56(4):2108-13. https://doi.org/10.1128/aac.06268-11
13. Mobarak Qamsari M, Sahebi L, Salehi MR, Labbani-Motlagh Z, ShavandiM, Alijani N, Amini Sh, Sefidbakht S, Feizabad MM. Respiratory bacterial and fungal superinfections during the third surge of the COVID-19 pandemic in Iran. Microbial Drug Resistance. 2023;29(3):104-11. https://doi.org/ 10.1089/mdr.2022.0227
14. Mobarak-Qamsari M, Jenaghi B, Sahebi L, Norouzi-Shadehi M, Salehi MR, Shakoori-Farahani A, Khoshnevis H, Abdollahi A, Feizabadi MM. Evaluation of Acinetobacter baumannii, Klebsiella pneumoniae, and Staphylococcus aureus respiratory tract superinfections among patients with COVID-19 at a tertiary-care hospital in Tehran, Iran. European Journal of Medical Research. 2023;28(1):314, https://doi.org/10.1186/s40001‑023‑01303‑3.
15. He Y, Guo X, Xiang S, Li J, Li X, Xiang H, He J, Chen D, Chen J. Comparative analyses of phenotypic methods and 16S rRNA, khe, rpoB genes sequencing for identification of clinical isolates of Klebsiella pneumoniae. Antonie Van Leeuwenhoek. 2016;109:1029-40. https://doi.org/10.1007/s10482-016-0702-9
16. Haeili M,Javani A, Moradi J, Jafari Z, Feizabadi MM, Babaei E. MgrB Alterations Mediate Colistin Resistance in Klebsiella pneumoniae Isolates from Iran. Journal of Medical Microbiology. 2018;68(1).https://doi.org/10.1099/jmm.0.000879
17. Chang D, Sharma L, Dela Cruz CS, Zhang D. Clinical epidemiology, risk factors, and control strategies of Klebsiella pneumoniae infection. Frontiers in microbiology. 2021;12:750662. https://doi.org/10.3389/fmicb.2021.750662
18. Wang Z, Qin R-R, Huang L, Sun L-Y. Risk factors for carbapenem-resistant Klebsiella pneumoniae infection and mortality of Klebsiella pneumoniae infection. Chinese medical journal. 2018;131(01):56-62. https://doi.org/10.4103/0366-6999.221267
19. Tumbarello M, Viale P, Viscoli C, Trecarichi EM, et al. Predictors of mortality in bloodstream infections caused by Klebsiella pneumoniae carbapenemase–producing K. pneumoniae: importance of combination therapy. Clinical infectious diseases. 2012;55(7):943-50
20. de Moraes LS, Magalhaes GLG, Soncini JGM, Pelisson M, Perugini MRE, Vespero EC. High mortality from carbapenem-resistant Klebsiella pneumoniae bloodstream infection. Microbial Pathogenesis. 2022;167:105519
21. Qala Nou MS, Amirian Z, Dehghani F, Vejdan A-K, Rooni R, Dehghanmehr S. Systematic review and meta-analysis on the carbapenem-resistant hypervirulent Klebsiella pneumoniae isolates. BMC Pharmacology and Toxicology. 2025;26(1):25
22. Xu L, Sun X, Ma X. Systematic review and meta-analysis of mortality of patients infected with carbapenem-resistant Klebsiella pneumoniae. Annals of clinical microbiology and antimicrobials. 2017;16:1-12. https://doi.org/10.1186/s12941-017-0191-3
23. Jiao Y, Qin Y, Liu J, Li Q,Dong Y, Shang Y, Huang Yi, Liu R. Risk factors for carbapenem-resistant Klebsiella pneumoniae infection/colonization and predictors of mortality: a retrospective study. Pathogens and global health. 2015;109(2):68-74. https://doi.org/10.1179/2047773215y.0000000004
24. Itani R, Khojah HM, Kibrit R, Raychouni H, Raychouni H, Shuhaiber P, Dib C, Hassan M, T Mukattash, A Lakany . Risk factors associated with multidrug-resistant Klebsiella pneumoniae infections: A multicenter observational study in Lebanese hospitals. BMC Public Health. 2024;24(1):2958. https://doi.org/10.1186/s12889-024-20474-0
25. Hsu J-Y, Chuang Y-C, Wang J-T, Chen Y-C, Hsieh SM. Healthcare-associated carbapenem-resistant Klebsiella pneumoniae bloodstream infections: Risk factors, mortality, and antimicrobial susceptibility, 2017–2019. Journal of the Formosan Medical Association. 2021;120(11):1994-2002. https://doi.org/10.1016/j.jfma.2021.04.014
26. Emamie A, Zolfaghari P, Zarei A, Ghorbani M. Prevalence and antibiotic resistance of ESKAPE pathogens isolated from patients with bacteremia in Tehran, Iran. Indian Journal of Medical Specialities. 2023;14(2):97-103. https://doi.org/10.4103/injms.injms_12_23
27. Kilinc M. Antibiotic Resistance and Mortality in ICU Patients: A Retrospective Analysis of First Culture Growth Results. Antibiotics. 2025;14(3):290. https://doi.org/10.3390/antibiotics14030290
28. Karakonstantis S, Kritsotakis EI, Gikas A. Treatment options for K. pneumoniae, P. aeruginosa and A. baumannii co-resistant to carbapenems, aminoglycosides, polymyxins and tigecycline: an approach based on the mechanisms of resistance to carbapenems. Infection. 2020;48(6):835-51.