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Published on: June 28, 2018
Intra-Abdominal Hypertension Contributes to the Development of Ventilator-Associated Pneumonia from Intestinal
Rui Zheng1, Yaxian Jiang1, Cheng Yan2
1Department of Clinical Laboratory, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, People's Republic of China.
Introduction:
Ventilator-associated pneumonia (VAP) is an ICU (intensive care unit)-acquired pulmonary parenchymal infection that is complicated by mechanical ventilation and is associated with high morbidity and mortality. Klebsiella pneumoniae (KPN) is known to asymptomatically colonize the gastrointestinal tract and may increase the incidence of corresponding VAP. Our study aims were to investigate the exact origin of the carbapenem-resistant Klebsiella pneumoniae (CRKP) causing VAP in our patient.
Methods:
Various environmental samples, including the patient's anal swab, were collected in order to find the source of the bacteria. Minimum inhibitory concentrations (MICs) for antimicrobial agents were determined according to the guidelines of the Clinical and Laboratory Standards Institute (CLSI); resistant genes were detected by using PCR and sequencing; clone relationships were analyzed by using multilocus-sequence typing (MLST) and pulsed field gel electrophoresis (PFGE). The IAP values were obtained via urinary catheter.
Results:
One CRKP strain was detected in the patient's anal swab; this strain was confirmed with the same gene type as the strain isolated from the sputum. We found that the patient's intra-abdominal pressure (IAP) was 29.41, 27.06, 24.12, and 22.66 mmHg; the IAP was either equal to or above 12 mmHg, on the operation day and the following three days. Intra-abdominal hypertension (IAH) occurred during the patient's hospitalization and was considered to be caused by the surgical procedure. Meanwhile, we found that there was a correlation between IAH and the detection of CRKP in the sputum. The findings suggested that his VAP was caused by intestinal colonial KPN, and not from the environment.
Discussion:
Our research illustrated that the ST11 KPC-2-producing strain colonized the intestinal tract and caused the development of VAP when the IAP was elevated. Routine screening for the intestinal carriage of CRKP, among patients in ICUs, can limit and prevent current and future outbreaks.
Insights
Carbapenem-resistant Klebsiella pneumoniae (CRKP) causing ventilator-associated pneumonia (VAP) in an ICU patient originated from the patient's own intestinal tract. Elevated intra-abdominal pressure (IAP) correlated with CRKP detection, suggesting a link between gut colonization and VAP development.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Ventilator-associated pneumonia (VAP) is a serious ICU-acquired infection with high mortality.
- Klebsiella pneumoniae (KPN) can asymptomatically colonize the gastrointestinal tract and lead to VAP.
- Carbapenem-resistant KPN (CRKP) poses a significant threat in healthcare settings.
Purpose of the Study:
- To determine the origin of CRKP causing VAP in an ICU patient.
- To investigate the potential link between intra-abdominal hypertension (IAH) and CRKP-VAP.
Main Methods:
- Collected environmental and patient samples (anal swab, sputum).
- Determined antimicrobial susceptibility (MICs), detected resistance genes (PCR, sequencing).
- Analyzed strain relatedness (MLST, PFGE) and measured intra-abdominal pressure (IAP).
Main Results:
- Identical CRKP strains were found in the patient's anal swab and sputum.
- Elevated IAP (≥12 mmHg) was observed, indicating intra-abdominal hypertension (IAH).
- A correlation was found between IAH and CRKP detection in sputum, suggesting VAP originated from intestinal colonization.
Conclusions:
- The ST11 KPC-2-producing CRKP strain colonized the intestine and caused VAP due to elevated IAP.
- Routine screening for intestinal CRKP carriage in ICU patients can help prevent outbreaks.
- Understanding the source of CRKP is crucial for effective infection control in intensive care units.
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