title: Clinical features of patients with carbapenem nonsusceptible Klebsiella pneumoniae and Escherichia coli in intensive care units: a nationwide multicenter study in Taiwan.
abstract: BACKGROUND
  Patients in intensive care units (ICUs) are especially prone to colonization and infection by carbapenem-resistant Enterobacteriaceae. We conducted a multicenter investigation to study the clinical and microbiological characteristics of patients with carbapenem nonsusceptible Klebsiella pneumoniae and Escherichia coli in ICUs of Taiwanese hospitals.
  
  
  METHODS
  Patients with carbapenem nonsusceptible K. pneumoniae and E. coli in ICUs from nine medical centers and eight regional hospitals in Taiwan were enrolled in 2012. Carbapenem nonsusceptibility was defined as a minimum inhibitory concentration of at least 2 mg/L for imipenem or meropenem. Clinical characteristics and risk factors for 30-day mortality were analyzed. Isolates were screened for antibiotic susceptibility and β-lactamase genes.
  
  
  RESULTS
  A total of 66 cases infected (n = 46) or colonized (n = 20) with carbapenem nonsusceptible K. pneumoniae (n = 60) and E. coli (n = 6) were identified during the study period. Nineteen isolates had genes that encoded carbapenemases (28.8%), including Klebsiella pneumoniae carbapenemase-2 (KPC-2) (n = 14), imipenemase-8 (IMP-8) (n = 1), Verona integron-encoded metallo-β-lactamase (VIM) (n = 3), and New Delhi metallo-β-lactamase-1 (NDM-1) (n = 1). The in-hospital mortality associated with non-susceptible K. pneumoniae and E. coli was 50%. The 30-day mortality of the 46 patients with infection was 50%. Septic shock was the only independent risk factor for 30-day mortality in patients with infection. The 30-day mortality rate was similar between patients with combination therapy and monotherapy.
  
  
  CONCLUSIONS
  Patients who acquired carbapenem nonsusceptible K. pneumoniae and E. coli in ICUs have a high mortality rate. Further clinical study is needed to deal with this emerging challenge.
authors: Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors: Yea-Yuan
authors: YY
authors: Chang
authors: Department of Internal Medicine and Medical Research, Chi Mei Medical Center, Tainan, Taiwan.
authors: Yin-Ching
authors: YC
authors: Chuang
authors: Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan.
authors: L Kristopher
authors: LK
authors: Siu
authors: Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors: Tsu-Lan
authors: TL
authors: Wu
authors: Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors: Jung-Chung
authors: JC
authors: Lin
authors: Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors: Po-Liang
authors: PL
authors: Lu
authors: Division of Infectious Diseases, Department of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Jann-Tay
authors: JT
authors: Wang
authors: Department of Infectious Diseases, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
authors: Lih-Shinn
authors: LS
authors: Wang
authors: Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: ytlin8@vghtpe.gov.tw.
authors: Yi-Tsung
authors: YT
authors: Lin
authors: Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors: Ling-Ju
authors: LJ
authors: Huang
authors: Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors: Chang-Phone
authors: CP
authors: Fung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015780:Carbapenems / Q000494:pharmacology*; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality / Q000473:pathology*; D005260:Female; D006761:Hospitals; D006801:Humans; D007362:Intensive Care Units; D007710:Klebsiella Infections / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality / Q000473:pathology*; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D001618:beta-Lactamases
keywords: Carbapenem; Escherichia coli; Intensive care unit; Klebsiella pneumoniae