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. 2024 May 12;13(5):435.
doi: 10.3390/antibiotics13050435.

Carbapenem-Resistant NDM and OXA-48- like Producing K. pneumoniae: From Menacing Superbug to a Mundane Bacteria; A Retrospective Study in a Romanian Tertiary Hospital

Dragos Stefan Lazar  1 , Maria Nica  1 , Amalia Dascalu  2 , Corina Oprisan  2 , Oana Albu  2 , Daniel Romeo Codreanu  2 , Alma Gabriela Kosa  2 , Corneliu Petru Popescu  1 , Simin Aysel Florescu  1
Affiliations

Carbapenem-Resistant NDM and OXA-48- like Producing K. pneumoniae: From Menacing Superbug to a Mundane Bacteria; A Retrospective Study in a Romanian Tertiary Hospital

Dragos Stefan Lazar et al. Antibiotics (Basel). .

Abstract

Background: Carbapenem-resistant Klebsiella pneumoniae (Cr-Kpn) is becoming a growing public health problem through the failure of adequate treatment. This study's objectives are to describe the sources of Cr-Kpn in our hospital over 22 months, associating factors with the outcome of Cr-Kpn-positive patients, especially those with NDM+OXA-48-like (New Delhi Metallo-β-Lactamase and oxacillinase-48), and the effectiveness of the treatments used.

Methods: A retrospective observational cohort study including all hospitalized patients with Cr-Kpn isolates. We reported data as percentages and identified independent predictors for mortality over hospital time through multivariate analysis.

Results: The main type of carbapenemases identified were NDM+OXA-48-like (49.4%). The statistical analysis identified that diabetes and co-infections with the Gram-negative, non-urinary sites of infection were factors of unfavorable evolution. The Cox regression model identified factors associated with a poor outcome: ICU admission (HR of 2.38), previous medical wards transition (HR of 4.69), and carbapenemase type NDM (HR of 5.98). We did not find the superiority of an antibiotic regimen, especially in the case of NDM+OXA-48-like.

Conclusions: The increase in the incidence of Cr-Kpn infections, especially with NDM+OXA-48-like pathogens, requires a paradigm shift in both the treatment of infected patients and the control of the spread of these pathogens, which calls for a change in public health policy regarding the use of antibiotics and the pursuit of a One Health approach.

Keywords: Carbapenem-resistant Klebsiella pneumoniae; ESKAPE pathogens; NDM+OXA-48-like; antibiotic therapies; carbapenemases.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Distribution of Carbapenemases upon Hospital Admission Based on Disease Severity.
Figure 2
Figure 2
Association of Gram-Negative (G-neg) Germs Coinfection with Carbapenemases from Isolates.
Figure 3
Figure 3
Probability of Survival Regarding Carbapenemase Types.
See this image and copyright information in PMC

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