Portal de investigación
Clinical outcomes and bacterial characteristics of carbapenem-resistant Klebsiella pneumoniae complex among patients from different global regions (CRACKLE-2): a prospective, multicentre, cohort study
Fecha de publicación:
Autores organización
Autores
- Wang M.
- Earley M.
- Chen L.
- Hanson B.M.
- Yu Y.
- Liu Z.
- Salcedo S.
- Cober E.
- Li L.
- Kanj S.S.
- Gao H.
- Munita J.M.
- Ordoñez K.
- Weston G.
- Satlin M.J.
- Valderrama-Beltrán S.L.
- Marimuthu K.
- Stryjewski M.E.
- Komarow L.
- Luterbach C.
- Rudin S.D.
- Manca C.
- Paterson D.L.
- Evans S.
- Hill C.
- Arias R.
- Baum K.
- Fries B.C.
- Doi Y.
- Patel R.
- Kreiswirth B.N.
- Bonomo R.A.
- Chambers H.F.
- Fowler V.G.
- Jr
- Arias C.A.
- van Duin D.
- Abbo L.M.
- Anderson D.J.
- Chew K.L.
- Cross H.R.
- De P.P.
- Desai S.
- Dhar S.
- Di Castelnuovo V.
- Diaz L.
- Dinh A.Q.
- Eilertson B.
- Evans B.
- Garcia-Diaz J.
- Garner O.B.
- Greenwood-Quaintance K.
- Hanson B.
- Herc E.
- Jacob J.T.
- Jiang J.
- Kalayjian R.C.
- Kaye K.S.
- Kim A.
- Lauterbach C.
- Marshall S.H.
- McCarty T.
- Munita J.
- Ng O.T.
- Oñate Gutierrez J.M.
- Peleg A.
- Salata R.A.
- Schmidt-Malan S.
- Smitasin N.
- Spencer M.
- Stryjewski M.
- Su J.
- Tambyah P.A.
- Valderrama S.
- Villegas Botero M.V.
- Waters M.
- Wong D.
- Wortmann G.
- Yang Y.
- Zhang F.
Grupos de investigación
Resumen
Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a global threat. We therefore analysed the bacterial characteristics of CRKP infections and the clinical outcomes of patients with CRKP infections across different countries. Methods: In this prospective, multicentre, cohort study (CRACKLE-2), hospitalised patients with cultures positive for CRKP were recruited from 71 hospitals in Argentina, Australia, Chile, China, Colombia, Lebanon, Singapore, and the USA. The first culture positive for CRKP was included for each unique patient. Clinical data on post-hospitalisation death and readmission were collected from health records, and whole genome sequencing was done on all isolates. The primary outcome was a desirability of outcome ranking at 30 days after the index culture, and, along with bacterial characteristics and 30-day all-cause mortality (a key secondary outcome), was compared between patients from China, South America, and the USA. The desirability of outcome ranking was adjusted for location before admission, Charlson comorbidity index, age at culture, Pitt bacteremia score, and anatomical culture source through inverse probability weighting; mortality was adjusted for the same confounders, plus region where relevant, through multivariable logistic regression. This study is registered at ClinicalTrials.gov, NCT03646227, and is complete. Findings: Between June 13, 2017, and Nov 30, 2018, 991 patients were enrolled, of whom 502 (51%) met the criteria for CRKP infection and 489 (49%) had positive cultures that were considered colonisation. We observed little intra-country genetic variation in CRKP. Infected patients from the USA were more acutely ill than were patients from China or South America (median Pitt bacteremia score 3 [IQR 2–6] vs 2 [0–4] vs 2 [0–4]) and had more comorbidities (median Charlson comorbidity index 3 [IQR 2–5] vs 1 [0–3] vs 1 [0–2]). Adjusted desirability of outcome ranking outcomes were similar in infected patients from China (n=246), South America (n=109), and the USA (n=130); the estimates were 53% (95% CI 42–65) for China versus South America, 50% (41–61) for the USA versus China, and 53% (41–66) for the USA versus South America. In patients with CRKP infections, unadjusted 30-day mortality was lower in China (12%, 95% CI 8–16; 29 of 246) than in the USA (23%, 16–30; 30 of 130) and South America (28%, 20–37; 31 of 109). Adjusted 30-day all-cause mortality was higher in South America than in China (adjusted odds ratio [aOR] 4·82, 95% CI 2·22–10·50) and the USA (aOR 3·34, 1·50–7·47), with the mortality difference between the USA and China no longer being significant (aOR 1·44, 0·70–2·96). Interpretation: Global CRKP epidemics have important regional differences in patients’ baseline characteristics and clinical outcomes, and in bacterial characteristics. Research findings from one region might not be generalisable to other regions. Funding: The National Institutes of Health. © 2022 Elsevier Ltd
Datos de la publicación
- ISSN/ISSNe:
- 1473-3099, 1474-4457
- Tipo:
- Article
- Páginas:
- 401-412
- Enlace a otro recurso:
- www.scopus.com
LANCET INFECTIOUS DISEASES Elsevier Ltd
Citas Recibidas en Web of Science: 88
Citas Recibidas en Scopus: 205
Documentos
- No hay documentos
Filiaciones
Keywords
- Anti-Bacterial Agents; Bacteremia; Carbapenem-Resistant Enterobacteriaceae; Carbapenems; Cohort Studies; Humans; Klebsiella Infections; Klebsiella pneumoniae; Prospective Studies; Respiratory Sounds; aerobactin; antibiotic agent; bacterial protein; beta lactamase; beta lactamase AmpC; beta lactamase CTX M; beta lactamase CTX M 15; beta lactamase CTX M 65; beta lactamase KPC; beta lactamase KPC 2; beta lactamase KPC 3; beta lactamase NDM; beta lactamase NDM 1; beta lactamase OXA 48; beta lactamase OXA 48 like; beta lactamase SHV; beta lactamase TEM; carbapenemase; colibactin; extended spectrum beta lactamase; ompk35 protein; ompk36 protein; porin; rmpa2 protein; rmpadc protein; unclassified drug; yersiniabactin; antiinfective agent; carbapenem derivative; acutely ill patient; adult; aged; all cause mortality; antibiotic therapy; Argentina; Article; Australia; bacteremia; bacterial colonization; bacterial strain; bacterial virulence; bacterium culture; bacterium isolate; carbapenem resis
Financiación
Proyectos asociados
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Citar la publicación
Wang M,Earley M,Chen L,Hanson BM,Yu Y,Liu Z,Salcedo S,Cober E,Li L,Kanj SS,Gao H,Munita JM,Ordoñez K,Weston G,Satlin MJ,Valderrama SL,Marimuthu K,Stryjewski ME,Komarow L,Luterbach C,Rudin SD,Manca C,Paterson DL,Reyes J,Villegas MV,Evans S,Hill C,Arias R,Baum K,Fries BC,Doi Y,Patel R,Kreiswirth BN,Bonomo RA,Chambers HF,Fowler VG,JR,Arias CA,van D,Abbo LM,Anderson DJ,Chew KL,Cross HR,PP,Desai S,Dhar S,Di V,Diaz L,Dinh AQ,Eilertson B,Evans B,Garcia J,Garner OB,Greenwood K,Hanson B,Herc E,Jacob JT,Jiang J,Kalayjian RC,Kaye KS,Kim A,Lauterbach C,Marshall SH,McCarty T,Munita J,Ng OT,Oñate JM,Peleg A,Salata RA,Schmidt S,Smitasin N,Spencer M,Stryjewski M,Su J,Tambyah PA,Valderrama S,Villegas MV,Waters M,Wong D,Wortmann G,Yang Y,Zhang F. Clinical outcomes and bacterial characteristics of carbapenem-resistant Klebsiella pneumoniae complex among patients from different global regions (CRACKLE-2): a prospective, multicentre, cohort study. Lancet Infect Dis. 2022. 22. (3):p. 401-412. IF:56,300. (1).