RT Journal Article
T1 Prognostic Significance of the Relative Load of KPC-Producing Klebsiella pneumoniae within the Intestinal Microbiota in a Prospective Cohort of Colonized Patients.
A1 Perez-Nadales, Elena
A1 M Natera, Alejandra
A1 Recio-Rufian, Manuel
A1 Guzman-Puche, Julia
A1 Marin-Sanz, Juan Antonio
A1 Martin-Perez, Carlos
A1 Cano, Angela
A1 Caston, Juan Jose
A1 Elias-Lopez, Cristina
A1 Machuca, Isabel
A1 Gutierrez-Gutierrez, Belen
A1 Martinez-Martinez, Luis
A1 Torre-Cisneros, Julian
K1 KPC-producing Klebsiella pneumoniae
K1 Bacterial load
K1 Infection
K1 Intestinal colonization
K1 Mortality
K1 Área de Gestión Sanitaria Nordeste de Granada
AB Increased relative bacterial load of KPC-producing Klebsiella pneumoniae (KPC-KP) within the intestinal microbiota has been associated with KPC-KP bacteremia. Prospective observational study of KPC-KP adult carriers with a hospital admission at recruitment or within the three prior months (January 2018 to February 2019). A qPCR-based assay was developed to measure the relative load of KPC-KP in rectal swabs (RLKPC, proportion of blaKPC relative to 16S rRNA gene copy number). We generated Fine-Gray competing risk and Cox regression models for survival analysis of all-site KPC-KP infection and all-cause mortality, respectively, at 90 and 30 days. The median RLKPC at baseline among 80 KPC-KP adult carriers was 0.28% (range 0.001% to 2.70%). Giannella Risk Score (GRS) was independently associated with 90-day and 30-day all-site infection (adjusted subdistribution hazard ratio [aHR] 1.23, 95% CI = 1.15 to 1.32, P 7, aHR 2.96, 95% CI = 0.97 to 9.07, P = 0.057). KPC-KP relative intestinal load was independently associated with all-cause mortality in our clinical setting, after adjusting for age and severe KPC-KP infection. Our study confirms the utility of GRS to predict infection risk in patients colonized by KPC-KP. IMPORTANCE The rapid dissemination of carbapenemase-producing Enterobacterales represents a global public health threat. Increased relative load of KPC-producing Klebsiella pneumoniae (KPC-KP) within the intestinal microbiota has been associated with an increased risk of bloodstream infection by KPC-KP. We developed a qPCR assay for quantification of the relative KPC-KP intestinal load (RLKPC) in 80 colonized patients and examined its association with subsequent all-site KPC-KP infection and all-cause mortality within 90 days. Giannella Risk Score, which predicts infection risk in colonized patients, was independently associated with the development of all-site KPC-KP infection. RLKPC was not associated with all-site KPC-KP infection, possibly reflecting the large heterogeneity in patient clinical conditions and infection types. RLKPC was an independent predictor of all-cause mortality within 90 and 30 days in our clinical setting. We hypothesize that KPC-KP load may behave as a surrogate marker for the severity of the patient's clinical condition.
PB American Society for Microbiology
YR 2022
FD 2022-05-20
LK http://hdl.handle.net/10668/20045
UL http://hdl.handle.net/10668/20045
LA en
NO Pérez-Nadales E, M Natera A, Recio-Rufián M, Guzmán-Puche J, Marín-Sanz JA, Martín-Pérez C, et al. Prognostic Significance of the Relative Load of KPC-Producing Klebsiella pneumoniae within the Intestinal Microbiota in a Prospective Cohort of Colonized Patients. Microbiol Spectr. 2022 Aug 31;10(4):e0272821
NO This work was supported by: (i) Plan Estatal de I1D1I 2013-2016, cofinanced by the ISCIII-Subdirección General de Evaluación y Fomento de la Investigación and the Fondo Europeo de Desarrollo Regional-FEDER (FIS PI16/01631-KLEBCOM granted to E.P.N.); (ii) Plan Nacional de I1D1i 2013-2016 and Instituto de Salud Carlos III (ISCIII), Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, and cofinanced by the European Development Regional Fund “A Way toAchieve Europe” Operative Program Smart Growth 2014–2020, Spanish Network for Research in Infectious Diseases (REIPI) (RD16/0016/0008); and (iii) Consejería de Salud y Familias, Junta de Andalucía (RH-0065-2020 granted to E.P.N.).
DS RISalud
RD Apr 6, 2025