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. 2017 Jan 9;1(2):352-370.
doi: 10.20411/pai.v1i2.109. eCollection 2016.

Clinical Usefulness of Klebsiella Pneumoniae Carbapenemase-Producing K. Pneumoniae Genotyping: The Experience of a Single-Center Epidemic

Marianna Rossi  1 , Liliane Chatenoud  2 , Egidio Franco Viganò  3 , Anna Maria Peri  1 , Laura Alagna  1 , Simone Bramati  3 , Monica Manenti  3 , Monica Raggi  3 , Annalisa Cavallero  3 , Luca Bisi  1 , Sebastiano Leone  1 , Guglielmo Marco Migliorino  1 , Alessandra Bandera  1 , Andrea Gori  1
Affiliations

Clinical Usefulness of Klebsiella Pneumoniae Carbapenemase-Producing K. Pneumoniae Genotyping: The Experience of a Single-Center Epidemic

Marianna Rossi et al. Pathog Immun. .

Abstract

Background: During the last decade, the spread of Klebsiella pneumoniae-carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) has increased dramatically worldwide. In this scenario, growing interest has been addressed to genotyping of KPC-Kp strains, which emerged as an important tool for a better understanding of the epidemiological and clinical characteristics of the outbreaks.

Methods: We performed a retrospective cohort study on patients infected with KPC-Kp during a 28-month outbreak period (January 2010-April 2012) at San Gerardo Hospital (Monza, Italy), investigating KPC-Kp genotypes by means of repetitive element sequence-based polymerase chain reaction (Rep-PCR).

Results: We enrolled 97 patients infected with KPC-Kp. Rep-PCR analysis identified 5 distinct clone types, with different distribution over time. During the first 12 months of the outbreak period, only 1 clone was detected (clone A, in 47 patients), while the 4 other clones were identified over the remaining 16 months (clones C, E, and F/L in 23, 24, and 3 patients respectively). Mechanical ventilation was less frequent in patients infected with clones C/E/F/L (OR = 0.14; 95% CI: 0.05-0.37) compared to clone A, and the Charlson comorbidity index (CI) was more likely to have a score >5 in patients infected with clones C/E/F/L (OR = 7.21; 95% CI: 2.24-23.14) compared to clone A.Overall mortality was higher in patients infected with clones C/E/F/L (13/20 patients, 65%) compared to those infected with clone A (7/20, 35%). Mortality in patients infected with clones C/E/F/L remained significantly higher even after adjusting for the potential confounding effect of comorbidities (ie, CI), with a hazard ratio (HR) of 4.65 (95% CI: 1.83-11.89).

Conclusions: Our results suggested a close relationship between strain genotype and clinical outcome.

Keywords: Enterobacteriaceae; KPC-Kp; carbapenemases; drug-resistant; genotyping profiles.

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Conflict of interest statement

All authors: No reported conflicts. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Incidence rate of KPC-Kp infections/10,000 days of hospitalization (IR). Number of cases is shown in brackets [n].
Figure 2.
Figure 2.
Number of KPC-Kp infected patients, identified by their KPC-clone, at the San Gerardo Hospital (a university public institution for adult and pediatric patients) in Monza, Italy since January 2010 (index case) and April 2012.
Figure 3.
Figure 3.
Antimicrobial treatment profile for the 97 patients considered.
Figure 4.
Figure 4.
Kaplan-Meier curves showing the impact of KPC-clones (C/E/F/L: red line) versus clone A (blue line) on 30-days mortality of patients with KPC infection. Figure 2A: overall mortality, Figure 2B: KPC-related mortality
Supplementary Figure 1.
Supplementary Figure 1.
The dendogram.
See this image and copyright information in PMC

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