Resistance Genes and Mortality in Carbapenem-resistant Klebsiella pneumoniae Bacteremias: Effects of the COVID-19 Pandemic

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dc.contributor.authorKurt, Ahmet Furkan
dc.contributor.authorTanriverdi, Elif Seren
dc.contributor.authorYalcin, Metin
dc.contributor.authorBayramlar, Osman Faruk
dc.contributor.authorKaya, Sibel Yildiz
dc.contributor.authorKaraali, Ridvan
dc.contributor.authorKuskucu, Mert Ahmet
dc.date.accessioned2026-04-04T13:30:51Z
dc.date.available2026-04-04T13:30:51Z
dc.date.issued2024
dc.departmentİnönü Üniversitesi
dc.description.abstractBackground: Emerging carbapenem-resistant Klebsiella pneumoniae (K. pneumoniae) (CRKP) bacteremias are presenting significant public health risks due to limited treatment options and increased mortality. K. pneumoniae isolates exhibit carbapenem resistance rates that vary from 25% to 50% throughout the European continent, including our country. Aims: To assess the characteristics of CRKP bacteremia, a condition that has recently demonstrated an increasing prevalence in our center. We sought to ascertain the resistance rates of isolated strains to antibiotics other than carbapenems, identify the responsible carbapenemase genes, evaluate the efficacy of antibiotics, determine mortality rates, explore clonality among strains, and investigate the influence of the COVID-19 pandemic on all these factors. Study Design: Retrospective observational study. Methods: This study included patients aged 18 and older who had experienced meropenem-resistant K. pneumoniae bacteremia. Meropenem resistance was confirmed by employing the Kirby-Bauer disk diffusion method. Meropenem minimum inhibitory concentration (MIC) levels were determined using the gradient test, while colistin MIC levels were ascertained using the disk elution technique. Carbapenemase genes were evaluated via colony polymerase chain reaction (PCR), and clonality analysis was performed using the arbitrarily primed PCR technique. Results: The study comprised 230 patients, with a mean age of 63.1 +/- 15.9 years, of whom 58.7% were male. Oxacillinase-48 (OXA-48) was detected in 74.8% of the patients, New Delhi metallo-beta-lactamase (NDM) in 12.6%, OXA-48 + NDM in 7.8%, and KPC in 4.8%. The 14-day and 30-day mortality rates were 57% and 69.6%, respectively. Multivariate analysis of the 30-day mortality revealed several crucial factors, including bacteremia development in the intensive care unit, the occurrence of bacteremia during the COVID-19 pandemic, polymicrobial bacteremia, the use of indwelling intravenous catheters, a platelet count of <= 140,000/ mu l, procalcitonin levels of >= 6 mu g/l, and a Charlson comorbidity score >= 3. Notably, the OXA-48 and KPC genes were upregulated significantly during the COVID-19 pandemic, while the NDM gene groups were downregulated. Additionally, both 14-day and 30-day mortality rates increased significantly. Conclusion: In this study, the most prevalent carbapenemase gene was OXA-48; however, there has been a recent increase in KPC genes. No dominant epidemic strain was identified through clonality analysis. The clustering rate was 68% before the pandemic, increasing to 85.7% during the pandemic. The significance of infection control measures is underscored by the rise in both clustering and mortality rates during the COVID-19 pandemic.
dc.description.sponsorshipThis study was funded by Scientific Research Projects Coordination Unit of stanbul University-Cerrahpaa (project number TTU-2022-36607)
dc.identifier.doi10.4274/balkanmedj.galenos.2024.2024-5-99
dc.identifier.endpage368
dc.identifier.issn2146-3123
dc.identifier.issn2146-3131
dc.identifier.issue5
dc.identifier.orcid0000-0002-0449-0356
dc.identifier.orcid0000-0002-7451-4149
dc.identifier.orcid0000-0001-7311-3258
dc.identifier.orcid0000-0002-6319-7889
dc.identifier.orcid0000-0003-2440-7529
dc.identifier.pmid39205634
dc.identifier.scopus2-s2.0-85203475721
dc.identifier.scopusqualityQ1
dc.identifier.startpage357
dc.identifier.trdizinid1273545
dc.identifier.urihttps://doi.org/10.4274/balkanmedj.galenos.2024.2024-5-99
dc.identifier.urihttps://search.trdizin.gov.tr/tr/yayin/detay/1273545
dc.identifier.urihttps://hdl.handle.net/11616/108419
dc.identifier.volume41
dc.identifier.wosWOS:001309254800006
dc.identifier.wosqualityQ1
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakTR-Dizin
dc.indekslendigikaynakPubMed
dc.language.isoen
dc.publisherGalenos Publ House
dc.relation.ispartofBalkan Medical Journal
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/openAccess
dc.snmzKA_WOS_20250329
dc.subjectPcr
dc.titleResistance Genes and Mortality in Carbapenem-resistant Klebsiella pneumoniae Bacteremias: Effects of the COVID-19 Pandemic
dc.typeArticle

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