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Risk factors of community-onset extended-spectrum β-lactamase-producing Klebsiella pneumoniae bacteraemia in South Korea using national health insurance claims data

Authors
 Yongseop Lee  ;  Young Ah Kim  ;  Dokyun Kim  ;  Jong Hee Shin  ;  Young Uh  ;  Kyeong Seob Shin  ;  Jeong Hwan Shin  ;  Seok Hoon Jeong  ;  Yoon Soo Park 
Citation
 INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS, Vol.54(6) : 723-727, 2019 
Journal Title
 INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS 
ISSN
 0924-8579 
Issue Date
2019
Keywords
Community-onset ; Extended-spectrum β-lactamase ; Klebsiella pneumoniae ; Risk factor
Abstract
BACKGROUND: Although it is essential to know the particular causes of antibiotic-resistant infections in the community, there is lack of evidence regarding risk factors for community-onset extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-KP) bacteraemia in South Korea. As such, this study aimed to identify risk factors for community-onset ESBL-KP bacteraemia. METHODS: From May 2016 to April 2017, patients with community-onset KP bloodstream infection (BSI) (n = 408) from six sentinel hospitals participating in the Global Antimicrobial Surveillance System in South Korea were included in this study. Risk factors of ESBL-KP BSI were assessed. Polymerase chain reaction and sequencing to identify genes encoding ESBLs and multi-locus sequence typing were performed. RESULTS: Of the 408 patients with community-onset KP BSI, 70 (17%) had ESBL-KP BSI. Admission to a long-term-care hospital within the previous 3 months [odds ratio (OR) 5.7, 95% confidence interval (CI) 2.1-15.6; P = 0.001], previous use of trimethoprim/sulfamethoxazole (TMP/SMT; OR 11.5, 95% CI 2.7-48.6; P = 0.001) or extended-spectrum cephalosporin (OR 2.2, 95% CI 1.2-3.9; P = 0.01), and previous use of a urinary catheter (OR 2.3, 95% CI 1.1-4.5; P = 0.02) were independent risk factors for community-onset ESBL-KP BSI. ESBL-KP isolates most frequently carried the CTX-M-1 group ESBL (74%, n = 52). The most prevalent sequence type (ST) among the ESBL-KP isolates was ST48 (14%, n = 10). Among non-ESBL-KP isolates, ST23 was most prevalent (21%, n = 70). CONCLUSION: Previous admission to a long-term-care hospital, use of a urinary catheter and use of TMP/SMT or extended-spectrum cephalosporin within the previous 3 months were identified as risk factors for community-onset ESBL-KP BSI. Strict antibiotic stewardship and infection control measures are needed for long-term-care hospitals.
Full Text
https://www.sciencedirect.com/science/article/pii/S0924857919302481
DOI
10.1016/j.ijantimicag.2019.09.005
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dokyun(김도균) ORCID logo https://orcid.org/0000-0002-0348-5440
Jeong, Seok Hoon(정석훈) ORCID logo https://orcid.org/0000-0001-9290-897X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/174652
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