EPIDEMIOLOGY OF CARBAPENEM-RESISTANT KLEBSIELLA PNEUMONIAE IN INTENSIVE CARE UNITS OF MULTIPROFILE HOSPITALS IN...

Klebsiella pneumoniae is one of the most frequent cause of health care associated infections. Dissemination of carbapenem-resistant (CR) K. pneumoniae infections significantly trend toward patient morbidity, length of stay and mortality. The aim of this research was to study prevalence and risk-factors of CR K. pneumoniae in Georgia. To identify risk factors for hospital-acquired carbapenem-resistant (CR) K. pneumoniae, from January 1, 2017 through February 28, 2018, an observational case-control study was performed in the ICUs of two tertiary-care hospitals in Tbilisi (High Medical Technology Centre and Ghudushauri National Medical Centre). All isolated K. pneumoniae cultures were tested on antibiotic susceptibility tests (AST). AST was performed by disk diffusion methods and E-test for MIC detection. For the first time CR K. pneumoniae isolates were screened for the presence of KPC, VIM, IMP, NDM and OXA carbapenemase in a PCR. Totally, 46 cultures of K. pneumoniae were isolated. Among them 20 (43.5%) were resistant to carbapenems. Most frequently CR K. pneumoniae cultures were isolated in patients with ventilator associated pneumonia (75%). Main risk factors of carbapenem-resistant from invasive procedures were: mechanical ventilation (OR 30.4, 95% CI 3.504-263.752, p=0.0003), nasogastric tube (OR 17.0, 95% CI 3.202-90.257, p=0.0002), central venous catheter (OR 10.06, 95% CI 1.152-87.849, p=0.028) and previous use of antibiotics (OR 10.059, 95% CI 1.152-87.849, p=0.028), especially carbapenem and 3rd generation cephalosporin. Predominant is OXA-producing K. pneumoniae, NDM-producing K. pneumoniae is relatively rare. To control dissemination of CR K. pneumoniae infection prevention and control should be toughened in medical facilities, and screening for early detection of patients with CR K. pneumoniae should be done.