Carbapenemase producing Enterobacteriaceae (CPE) is major pathogens in nosocomial infections, and disease burden due to CPE is also on the rise globally. Nevertheless, only few studies have been conducted regarding CPE infection and its epidemiological factors in the Republic of Korea (ROK). In this Paper, we analyzed clinical, microbiological, and epidemiological characteristics of CPE bloodstream infection (BSI) in ROK.
We designed retrospective cohort study by analyzing reports of epidemiological conducted by Epidemic Investigation Officers in KCDC from January 2015 to December 2016. CPE infected cases were collected through the nationwide surveillance system. Numbers of sentinel surveillance hospitals included in the system were 100 hospitals in year 2015, and 115 hospitals in 2016. We selected cases with confirmed CPE BSI by Korea National Institute of Health that detected gene types of carbapenemase.
Total of 131 CPE BSI were identified during the study period. Prevalence of CPE BSI among total CPE isolates was 7%. Nationwide, Klebsiella pneumoniae accounts for 69% of CPE BSI and 66% produced K. pneumoniae carbapenemase (KPC). The antibiotics susceptibility exam results showed that CPE prevalent in ROK had susceptibility to Amkacin, Tigecycline, or Gentamicin (76%, 41%, and 39%, respectively). Colistin sensitivity test was performed on only 29 patients, and 1 of those patients showed colistin resistance. 85% (111/131) of cases were classified to hospital acquired infections. Prevalence of CPE BSI among CPE isolates was 7% (131/2020). Most common BSI sources were lung (29%), primary (16%), and biliary tract (15%). Thirty-day mortality rate due to CPE BSI was 47.3%. A multivariable analysis showed that use of adequate antibiotics for CPE (p=0.01) and APACHE II score (p<0.001) at the time of CPE detection in the blood stream were significantly associated with decreased 30-day mortality.
CPE bacteremic episodes were already prevalent in the Republic of Korea. Moreover, most of CPE BSI originated from hospital acquired infection, pointing out the need for improvement of hospital infection control strategies. Use of adequate antibiotics therapies upon recognition of CPE infection could decrease mortality due to CPE blood stream infections.
J. W. Park,
H. Lee, None
T. H. Kim, None
E. J. Lee, None
E. Lee, None
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