Risk factors, clinical outcomes of patients with Ceftazidime/Avibactam-resistant carbapenem-Resistant Klebsiella pneumoniae infection and its potential resistant mechanisms

IF 4.8 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2026-04-01 Epub Date: 2026-01-31 DOI:10.1016/j.jiph.2026.103161

Zhenchao Wu , Yanqiu Ma , Jiajia Zheng , Ping Yang , Ming Lu , Du Yipeng , Ning Shen

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引用次数: 0

Abstract

Background

Ceftazidime/avibactam (CZA) resistance (CZAr) poses critical challenges for the treatment of carbapenem-resistant Klebsiella pneumoniae (CRKP) infections. The early identification of high-risk populations is essential for controlling nosocomial transmission and guiding empirical therapy. This study aimed to systematically focus on the correlation between the clinical characteristics of patients and the microbial features of CZArCRKP.

Methods

We conducted a retrospective cohort study (January 2020-May 2023) of 97 patients with CRKP infection. Antimicrobial susceptibility testing and whole-genome sequencing (WGS) were used to analyze resistance phenotype-genotype correlations. Survival outcomes were evaluated using Kaplan–Meier analysis.

Results

CZArCRKP primarily caused lower respiratory (72.16 %) and urinary tract (16.49 %) infections, predominantly affecting elderly patients with comorbidities (81.4 %) or undergoing invasive procedures (63.9 %). Chronic renal failure combined with platelet counts > 149× 10⁹/L post-infection strongly predicted patients with CZArCRKP in pulmonary infections. NDM-1 gene carriage and OmpK36 mutations were associated with CZA resistance. CZA-treated patients demonstrated lower 14-day mortality rates.

Conclusion

We established the first integrated host-pathogen risk model for CZArCRKP and identified chronic renal failure and platelet count as key clinical predictors. NDM-1/OmpK36 mutations represents a clear mechanism of resistance. CZA use may improve the survival of selected patients with CRKP. These findings advance the surveillance and therapeutic strategies for multidrug-resistant infections.

查看原文本刊更多论文

头孢他啶/阿维巴坦耐碳青霉烯耐药肺炎克雷伯菌感染的危险因素、临床结局及其潜在耐药机制

头孢他啶/阿维巴坦（CZA）耐药（CZAr）对耐碳青霉烯肺炎克雷伯菌（CRKP）感染的治疗提出了严峻挑战。早期识别高危人群对控制院内传播和指导经验性治疗至关重要。本研究旨在系统探讨CZArCRKP患者临床特征与微生物特征的相关性。方法对97例CRKP感染患者进行回顾性队列研究（2020年1月- 2023年5月）。采用药敏试验和全基因组测序（WGS）分析耐药表型与基因型的相关性。使用Kaplan-Meier分析评估生存结果。结果sczarcrkp主要引起下呼吸道感染（72.16 %）和泌尿道感染（16.49 %），主要影响有合并症的老年患者（81.4 %）或有创手术患者（63.9 %）。慢性肾衰竭合并血小板计数>； 149× 10⁹/L感染后强烈预测肺部感染的CZArCRKP患者。NDM-1基因携带和OmpK36突变与CZA耐药相关。经cza治疗的患者14天死亡率较低。结论建立了首个CZArCRKP的综合宿主-病原体风险模型，并确定慢性肾功能衰竭和血小板计数是关键的临床预测因子。NDM-1/OmpK36突变代表了一个明确的耐药机制。使用CZA可能会提高CRKP患者的生存率。这些发现促进了多药耐药感染的监测和治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.