Increased Relative Abundance of Klebsiella pneumoniae Carbapenemase-producing Klebsiella pneumoniae Within the Gut Microbiota Is Associated With Risk of Bloodstream Infection in Long-term Acute Care Hospital Patients.

Autor:	Shimasaki T; Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois., Seekatz A; Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor., Bassis C; Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor., Rhee Y; Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois., Yelin RD; Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois., Fogg L; Department of Nursing, Rush University Medical Center, Chicago, Illinois., Dangana T; Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois., Cisneros EC; Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois.; Hospital Nacional Cayetano Heredia, Lima, Peru., Weinstein RA; Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois., Okamoto K; Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois.; University of Tokyo Hospital, Japan., Lolans K; Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois., Schoeny M; Department of Nursing, Rush University Medical Center, Chicago, Illinois., Lin MY; Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois., Moore NM; Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois., Young VB; Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor., Hayden MK; Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2019 May 30; Vol. 68 (12), pp. 2053-2059.
DOI:	10.1093/cid/ciy796
Abstrakt:	Background: An association between increased relative abundance of specific bacterial taxa in the intestinal microbiota and bacteremia has been reported in some high-risk patient populations. Methods: We collected weekly rectal swab samples from patients at 1 long-term acute care hospital (LTACH) in Chicago from May 2015 to May 2016. Samples positive for Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) by polymerase chain reaction and culture underwent 16S rRNA gene sequence analysis; relative abundance of the operational taxonomic unit containing KPC-Kp was determined. Receiver operator characteristic (ROC) curves were constructed using results from the sample with highest relative abundance of KPC-Kp from each patient admission, excluding samples collected after KPC-Kp bacteremia. Cox regression analysis was performed to evaluate risk factors associated with time to achieve KPC-Kp relative abundance thresholds calculated by ROC curve analysis. Results: We collected 2319 samples from 562 admissions (506 patients); KPC-Kp colonization was detected in 255 (45.4%) admissions and KPC-Kp bacteremia in 11 (4.3%). A relative abundance cutoff of 22% predicted KPC-Kp bacteremia with sensitivity 73%, specificity 72%, and relative risk 4.2 (P = .01). In a multivariable Cox regression model adjusted for age, Charlson comorbidity index, and medical devices, carbapenem receipt was associated with achieving the 22% relative abundance threshold (P = .044). Conclusion: Carbapenem receipt was associated with increased hazard for high relative abundance of KPC-Kp in the gut microbiota. Increased relative abundance of KPC-Kp was associated with KPC-Kp bacteremia. Whether bacteremia arose directly from bacterial translocation or indirectly from skin contamination followed by bloodstream invasion remains to be determined. (© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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