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Trends in Resistance to Carbapenems and Third-Generation Cephalosporins among Clinical Isolates of Klebsiella pneumoniae in the United States, 1999–2010

Published online by Cambridge University Press:  02 January 2015

Nikolay P. Braykov
Affiliation:
Center for Disease Dynamics, Economics and Policy, Washington, DC
Michael R. Eber
Affiliation:
Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California
Eili Y. Klein
Affiliation:
Center for Disease Dynamics, Economics and Policy, Washington, DC Center for Advanced Modeling, Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland
Daniel J. Morgan
Affiliation:
VA Maryland Healthcare System, Baltimore, Maryland University of Maryland School of Medicine Department of Epidemiology and Public Health, Baltimore, Maryland
Ramanan Laxminarayan
Affiliation:
Center for Disease Dynamics, Economics and Policy, Washington, DC Public Health Foundation of India, New Delhi, India Princeton Environmental Institute, Princeton University, Princeton, New Jersey
Corresponding
E-mail address:

Abstract

Objective.

Multidrug-resistant Enterobacteriaceae pose a serious infection control challenge and have emerged as a public health threat. We examined national trends in the proportion of Klebsiella pneumoniae isolates resistant to carbapenems (CRKP) and third-generation cephalosporins (G3CRKP).

Design and Setting.

Retrospective analysis of approximately 500,000 K. pneumoniae isolates cultured between January 1999 and July 2010 at 287 clinical laboratories throughout the United States.

Methods.

Isolates were defined as CRKP if they were nonsusceptible to 1 or more carbapenems and were defined as G3CRKP if they were nonsusceptible to ceftazidime, ceftriaxone, or related antibiotics. A multivariable analysis examined trends in the proportion of resistant isolates, adjusting for age, sex, isolate source, patient location, and geographic region.

Results.

The crude proportion of CRKP increased from less than 0.1% to 4.5% between 2002 and 2010; the frequency of G3CRKP increased from 5.3% to 11.5% between 1999 and 2010. G3CRKP and CRKP were more common among elderly patients (those greater than 65 years of age); the adjusted odds ratio (aOR) relative to pediatric patients (those less than 18 years of age) was 1.2 for G3CRKP (95% confidence interval [CI], 1.2–1.3) and 3.3 for CRKP (95% CI, 2.6–4.2). G3CRKP and CRKP were also more common among patients from the northeastern United States (aOR, 2.9 [95% CI, 2.8–3.0] and 9.0 [95% CI, 7.9–10.4]) than among those from the western United States. The prevalence of outpatient CRKP isolates increased after 2006, reaching 1.9% of isolates in our sample in 2010 (95% CI, 1.6%–2.1%).

Conclusions.

The frequency of G3CRKP and CRKP is increasing in all regions of the United States, and resistance is emerging among isolates recovered in the outpatient setting. This underscores the need for enhanced laboratory capacity and coordinated surveillance strategies to contain the further spread of these emerging pathogens.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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