Impact of the ST101 clone on fatality among patients with colistin-resistant Klebsiella pneumoniae infection

Fusun Can, Sirin Menekse, Pelin Ispir, Nazli Atac, Ozgur Albayrak, Tuana Demir, Doruk Can Karaaslan, Salih Nafiz Karahan, Mahir Kapmaz, Ozlem Kurt Azap, Funda Timurkaynak, Serap Simsek Yavuz, Seniha Basaran, Fugen Yoruk, Alpay Azap, Safiye Koculu, Nur Benzonana, Nathan A. Lack, Mehmet Gonen, Onder Ergonul

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objectives: We describe the molecular characteristics of colistin resistance and its impact on patient mortality. Methods: A prospective cohort study was performed in seven different Turkish hospitals. The genotype of each isolate was determined by MLST and repetitive extragenic palindromic PCR (rep-PCR). Alterations in mgrB were detected by sequencing. Upregulation of pmrCAB, phoQ and pmrK was quantified by RT-PCR. mcr-1 and the genes encoding OXA-48, NDM-1 and KPC were amplified by PCR. Results: A total of 115 patients diagnosed with colistin-resistant K. pneumoniae (ColR-Kp) infection were included. Patients were predominantly males (55%) with a median age of 63 (IQR 46-74) and the 30 day mortality rate was 61%. ST101 was the most common ST and accounted for 68 (59%) of the ColR-Kp. The 30 day mortality rate in patients with these isolates was 72%. In ST101, 94% (64/68) of the isolates had an altered mgrB gene, whereas the alteration occurred in 40% (19/47) of non-ST101 isolates. The OXA-48 and NDM-1 carbapenemases were found in 93 (81%) and 22 (19%) of the total 115 isolates, respectively. In multivariate analysis for the prediction of 30 day mortality, ST101 (OR 3.4, CI 1.46-8.15, P"0.005) and ICU stay (OR 7.4, CI 2.23-29.61, P"0.002) were found to be significantly associated covariates. Conclusions: Besides ICU stay, ST101 was found to be a significant independent predictor of patient mortality among those infected with ColR-Kp. A significant association was detected between ST101 and OXA-48. ST101 may become a global threat in the dissemination of colistin resistance and the increased morbidity and mortality of K. pneumoniae infection.

Original languageEnglish (US)
Pages (from-to)1235-1241
Number of pages7
JournalJournal of Antimicrobial Chemotherapy
Volume73
Issue number5
DOIs
StatePublished - May 1 2018
Externally publishedYes

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Klebsiella Infections
Colistin
Klebsiella pneumoniae
Clone Cells
Mortality
Polymerase Chain Reaction
Genes
Cohort Studies
Up-Regulation
Multivariate Analysis
Genotype
Prospective Studies
Morbidity

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Impact of the ST101 clone on fatality among patients with colistin-resistant Klebsiella pneumoniae infection. / Can, Fusun; Menekse, Sirin; Ispir, Pelin; Atac, Nazli; Albayrak, Ozgur; Demir, Tuana; Karaaslan, Doruk Can; Karahan, Salih Nafiz; Kapmaz, Mahir; Azap, Ozlem Kurt; Timurkaynak, Funda; Yavuz, Serap Simsek; Basaran, Seniha; Yoruk, Fugen; Azap, Alpay; Koculu, Safiye; Benzonana, Nur; Lack, Nathan A.; Gonen, Mehmet; Ergonul, Onder.

In: Journal of Antimicrobial Chemotherapy, Vol. 73, No. 5, 01.05.2018, p. 1235-1241.

Research output: Contribution to journalArticle

Can, F, Menekse, S, Ispir, P, Atac, N, Albayrak, O, Demir, T, Karaaslan, DC, Karahan, SN, Kapmaz, M, Azap, OK, Timurkaynak, F, Yavuz, SS, Basaran, S, Yoruk, F, Azap, A, Koculu, S, Benzonana, N, Lack, NA, Gonen, M & Ergonul, O 2018, 'Impact of the ST101 clone on fatality among patients with colistin-resistant Klebsiella pneumoniae infection', Journal of Antimicrobial Chemotherapy, vol. 73, no. 5, pp. 1235-1241. https://doi.org/10.1093/jac/dkx532
Can, Fusun ; Menekse, Sirin ; Ispir, Pelin ; Atac, Nazli ; Albayrak, Ozgur ; Demir, Tuana ; Karaaslan, Doruk Can ; Karahan, Salih Nafiz ; Kapmaz, Mahir ; Azap, Ozlem Kurt ; Timurkaynak, Funda ; Yavuz, Serap Simsek ; Basaran, Seniha ; Yoruk, Fugen ; Azap, Alpay ; Koculu, Safiye ; Benzonana, Nur ; Lack, Nathan A. ; Gonen, Mehmet ; Ergonul, Onder. / Impact of the ST101 clone on fatality among patients with colistin-resistant Klebsiella pneumoniae infection. In: Journal of Antimicrobial Chemotherapy. 2018 ; Vol. 73, No. 5. pp. 1235-1241.
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abstract = "Objectives: We describe the molecular characteristics of colistin resistance and its impact on patient mortality. Methods: A prospective cohort study was performed in seven different Turkish hospitals. The genotype of each isolate was determined by MLST and repetitive extragenic palindromic PCR (rep-PCR). Alterations in mgrB were detected by sequencing. Upregulation of pmrCAB, phoQ and pmrK was quantified by RT-PCR. mcr-1 and the genes encoding OXA-48, NDM-1 and KPC were amplified by PCR. Results: A total of 115 patients diagnosed with colistin-resistant K. pneumoniae (ColR-Kp) infection were included. Patients were predominantly males (55{\%}) with a median age of 63 (IQR 46-74) and the 30 day mortality rate was 61{\%}. ST101 was the most common ST and accounted for 68 (59{\%}) of the ColR-Kp. The 30 day mortality rate in patients with these isolates was 72{\%}. In ST101, 94{\%} (64/68) of the isolates had an altered mgrB gene, whereas the alteration occurred in 40{\%} (19/47) of non-ST101 isolates. The OXA-48 and NDM-1 carbapenemases were found in 93 (81{\%}) and 22 (19{\%}) of the total 115 isolates, respectively. In multivariate analysis for the prediction of 30 day mortality, ST101 (OR 3.4, CI 1.46-8.15, P{"}0.005) and ICU stay (OR 7.4, CI 2.23-29.61, P{"}0.002) were found to be significantly associated covariates. Conclusions: Besides ICU stay, ST101 was found to be a significant independent predictor of patient mortality among those infected with ColR-Kp. A significant association was detected between ST101 and OXA-48. ST101 may become a global threat in the dissemination of colistin resistance and the increased morbidity and mortality of K. pneumoniae infection.",
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T1 - Impact of the ST101 clone on fatality among patients with colistin-resistant Klebsiella pneumoniae infection

AU - Can, Fusun

AU - Menekse, Sirin

AU - Ispir, Pelin

AU - Atac, Nazli

AU - Albayrak, Ozgur

AU - Demir, Tuana

AU - Karaaslan, Doruk Can

AU - Karahan, Salih Nafiz

AU - Kapmaz, Mahir

AU - Azap, Ozlem Kurt

AU - Timurkaynak, Funda

AU - Yavuz, Serap Simsek

AU - Basaran, Seniha

AU - Yoruk, Fugen

AU - Azap, Alpay

AU - Koculu, Safiye

AU - Benzonana, Nur

AU - Lack, Nathan A.

AU - Gonen, Mehmet

AU - Ergonul, Onder

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Objectives: We describe the molecular characteristics of colistin resistance and its impact on patient mortality. Methods: A prospective cohort study was performed in seven different Turkish hospitals. The genotype of each isolate was determined by MLST and repetitive extragenic palindromic PCR (rep-PCR). Alterations in mgrB were detected by sequencing. Upregulation of pmrCAB, phoQ and pmrK was quantified by RT-PCR. mcr-1 and the genes encoding OXA-48, NDM-1 and KPC were amplified by PCR. Results: A total of 115 patients diagnosed with colistin-resistant K. pneumoniae (ColR-Kp) infection were included. Patients were predominantly males (55%) with a median age of 63 (IQR 46-74) and the 30 day mortality rate was 61%. ST101 was the most common ST and accounted for 68 (59%) of the ColR-Kp. The 30 day mortality rate in patients with these isolates was 72%. In ST101, 94% (64/68) of the isolates had an altered mgrB gene, whereas the alteration occurred in 40% (19/47) of non-ST101 isolates. The OXA-48 and NDM-1 carbapenemases were found in 93 (81%) and 22 (19%) of the total 115 isolates, respectively. In multivariate analysis for the prediction of 30 day mortality, ST101 (OR 3.4, CI 1.46-8.15, P"0.005) and ICU stay (OR 7.4, CI 2.23-29.61, P"0.002) were found to be significantly associated covariates. Conclusions: Besides ICU stay, ST101 was found to be a significant independent predictor of patient mortality among those infected with ColR-Kp. A significant association was detected between ST101 and OXA-48. ST101 may become a global threat in the dissemination of colistin resistance and the increased morbidity and mortality of K. pneumoniae infection.

AB - Objectives: We describe the molecular characteristics of colistin resistance and its impact on patient mortality. Methods: A prospective cohort study was performed in seven different Turkish hospitals. The genotype of each isolate was determined by MLST and repetitive extragenic palindromic PCR (rep-PCR). Alterations in mgrB were detected by sequencing. Upregulation of pmrCAB, phoQ and pmrK was quantified by RT-PCR. mcr-1 and the genes encoding OXA-48, NDM-1 and KPC were amplified by PCR. Results: A total of 115 patients diagnosed with colistin-resistant K. pneumoniae (ColR-Kp) infection were included. Patients were predominantly males (55%) with a median age of 63 (IQR 46-74) and the 30 day mortality rate was 61%. ST101 was the most common ST and accounted for 68 (59%) of the ColR-Kp. The 30 day mortality rate in patients with these isolates was 72%. In ST101, 94% (64/68) of the isolates had an altered mgrB gene, whereas the alteration occurred in 40% (19/47) of non-ST101 isolates. The OXA-48 and NDM-1 carbapenemases were found in 93 (81%) and 22 (19%) of the total 115 isolates, respectively. In multivariate analysis for the prediction of 30 day mortality, ST101 (OR 3.4, CI 1.46-8.15, P"0.005) and ICU stay (OR 7.4, CI 2.23-29.61, P"0.002) were found to be significantly associated covariates. Conclusions: Besides ICU stay, ST101 was found to be a significant independent predictor of patient mortality among those infected with ColR-Kp. A significant association was detected between ST101 and OXA-48. ST101 may become a global threat in the dissemination of colistin resistance and the increased morbidity and mortality of K. pneumoniae infection.

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DO - 10.1093/jac/dkx532

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