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Colistin Resistance in Carbapenem-Resistant Klebsiella pneumoniae: Laboratory Detection and Impact on Mortality.

Publication ,  Journal Article
Rojas, LJ; Salim, M; Cober, E; Richter, SS; Perez, F; Salata, RA; Kalayjian, RC; Watkins, RR; Marshall, S; Rudin, SD; Domitrovic, TN; Doi, Y ...
Published in: Clin Infect Dis
March 15, 2017

BACKGROUND: Polymyxins including colistin are an important "last-line" treatment for infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKp). Increasing use of colistin has led to resistance to this cationic antimicrobial peptide. METHODS: A cohort nested within the Consortium on Resistance against Carbapenems in Klebsiella pneumoniae (CRACKLE) was constructed of patients with infection, or colonization with CRKp isolates tested for colistin susceptibility during the study period of December, 2011 to October, 2014. Reference colistin resistance determination as performed by broth macrodilution was compared to results from clinical microbiology laboratories (Etest) and to polymyxin resistance testing. Each patient was included once, at the time of their first colistin-tested CRKp positive culture. Time to 30-day in-hospital all-cause mortality was evaluated by Kaplan-Meier curves and Cox proportional hazard modeling. RESULTS: In 246 patients with CRKp, 13% possessed ColR CRKp. ColR was underestimated by Etest (very major error rate = 35%, major error rate = 0.4%). A variety of rep-PCR strain types were encountered in both the ColS and the ColR groups. Carbapenem resistance was mediated primarily by blaKPC-2 (46%) and blaKPC-3 (50%). ColR was associated with increased hazard for in-hospital mortality (aHR 3.48; 95% confidence interval, 1.73-6.57; P < .001). The plasmid-associated ColR genes, mcr-1 and mcr-2 were not detected in any of the ColR CRKp. CONCLUSIONS: In this cohort, 13% of patients with CRKp presented with ColR CRKp. The apparent polyclonal nature of the isolates suggests de novo emergence of ColR in this cohort as the primary factor driving ColR. Importantly, mortality was increased in patients with ColR isolates.

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Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

March 15, 2017

Volume

64

Issue

6

Start / End Page

711 / 718

Location

United States

Related Subject Headings

  • beta-Lactamases
  • beta-Lactam Resistance
  • Proportional Hazards Models
  • Phylogeny
  • Middle Aged
  • Microbiology
  • Microbial Sensitivity Tests
  • Male
  • Klebsiella pneumoniae
  • Klebsiella Infections
 

Citation

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Rojas, L. J., Salim, M., Cober, E., Richter, S. S., Perez, F., Salata, R. A., … Antibacterial Resistance Leadership Group, . (2017). Colistin Resistance in Carbapenem-Resistant Klebsiella pneumoniae: Laboratory Detection and Impact on Mortality. Clin Infect Dis, 64(6), 711–718. https://doi.org/10.1093/cid/ciw805
Rojas, Laura J., Madiha Salim, Eric Cober, Sandra S. Richter, Federico Perez, Robert A. Salata, Robert C. Kalayjian, et al. “Colistin Resistance in Carbapenem-Resistant Klebsiella pneumoniae: Laboratory Detection and Impact on Mortality.Clin Infect Dis 64, no. 6 (March 15, 2017): 711–18. https://doi.org/10.1093/cid/ciw805.
Rojas LJ, Salim M, Cober E, Richter SS, Perez F, Salata RA, et al. Colistin Resistance in Carbapenem-Resistant Klebsiella pneumoniae: Laboratory Detection and Impact on Mortality. Clin Infect Dis. 2017 Mar 15;64(6):711–8.
Rojas, Laura J., et al. “Colistin Resistance in Carbapenem-Resistant Klebsiella pneumoniae: Laboratory Detection and Impact on Mortality.Clin Infect Dis, vol. 64, no. 6, Mar. 2017, pp. 711–18. Pubmed, doi:10.1093/cid/ciw805.
Rojas LJ, Salim M, Cober E, Richter SS, Perez F, Salata RA, Kalayjian RC, Watkins RR, Marshall S, Rudin SD, Domitrovic TN, Hujer AM, Hujer KM, Doi Y, Kaye KS, Evans S, Fowler VG, Bonomo RA, van Duin D, Antibacterial Resistance Leadership Group. Colistin Resistance in Carbapenem-Resistant Klebsiella pneumoniae: Laboratory Detection and Impact on Mortality. Clin Infect Dis. 2017 Mar 15;64(6):711–718.
Journal cover image

Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

March 15, 2017

Volume

64

Issue

6

Start / End Page

711 / 718

Location

United States

Related Subject Headings

  • beta-Lactamases
  • beta-Lactam Resistance
  • Proportional Hazards Models
  • Phylogeny
  • Middle Aged
  • Microbiology
  • Microbial Sensitivity Tests
  • Male
  • Klebsiella pneumoniae
  • Klebsiella Infections