Risk factors and molecular epidemiology of extended-spectrum β-lactamase-producing Klebsiella pneumoniae in Xiamen, China. (December 2017)

• Record Type: Journal Article
• Authors: Deng, Jie; Li, Yan-Ting; Shen, Xu; Yu, Yi-Wen; Lin, Hui-Ling; Zhao, Qi-Feng; Yang, Tian-Ci; Li, Shu-Lian; Niu, Jian-Jun
• Is Part Of: Journal of global antimicrobial resistance. Volume 11(2017)
• Page Start: 23
• Page End: 27
• Publication Date: 2017-12
• Subjects: Extended-spectrum β-lactamase -- Klebsiella pneumoniae -- Risk factors -- Sequences type; Drug resistance -- Periodicals; Drug resistance -- Periodicals; Drug resistance; Periodicals; 616.9041
• DOI: 10.1016/j.jgar.2017.04.015
• Languages: English
• ISSNs: 2213-7165

Abstract

Highlights: A retrospective study of pneumonia due to ESBL-producing Klebsiella pneumoniae (ESBL-KP) was performed. Cephalosporin use and presence of a nasogastric tube were the most important risk factors for ESBL-KP infection. 28 sequence types (STs) were identified among 40 ESBL-KP strains. Three novel STs were identified. Abstract: Objectives: The aim of this study was to evaluate the risk factors for pneumonia due to extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-KP) and to analyse the molecular epidemiology of ESBL-KP in Xiamen, China. Methods: A case–control study was conducted at Zhongshan Hospital from January 2014 to August 2015. Medical records of patients with nosocomial pneumonia caused by K. pneumoniae were collected. A total of 40 cases with ESBL-KP infection and 90 controls with non-ESBL-KP infection were included. The sequence types (STs) of the 40 ESBL-KP strains were determined by multilocus sequence typing (MLST). Results: Univariate analysis primarily revealed an association between the following seven risk factors and ESBL-KP infection ( P < 0.10): length of hospitalisation; use of cephalosporins; use of quinolones; presence of a nasogastric tube; presence of an intravenous catheter; mechanical ventilation; and cerebrospinal fluid drainage. Furthermore, multivariate analysis revealed that use of cephalosporins and presence of a nasogastric tube were independent risk factors for ESBL-KP infection ( P < 0.05), with adjusted odds ratios of 3.473 [95% confidence interval (CI) 1.105–10.911; P = 0.033] and 2.488 (95% CI 1.083–5.715; P = 0.032), respectively. MLST identified 28 STs. The main STs were ST23 (10.0%) and ST37 (10.0%); three novel STs were identified. Conclusions: Use of cephalosporins and presence of a nasogastric tube are independent risk factors for ESBL-KP infection. In addition, the discovery of three novel STs serves as a reminder to continuously monitor outbreaks of ESBL-KP infection.