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Clinical outcomes and bacterial characteristics of carbapenem-resistant Klebsiella pneumoniae complex among patients from different global regions (CRACKLE-2): a prospective, multicentre, cohort study
Open accessAbstract
Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) are a global threat. We analyzed clinical outcomes of patients with CRKP in different countries and associated bacterial characteristics. Methods: The second Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE-2, ClinicalTrials.gov: NCT03646227) is a prospective, multicenter, cohort study. Patients were hospitalized in Argentina, Australia, Chile, China, Colombia, Lebanon, Singapore, and the US, with clinical cultures positive for CRKP in 2017–2018. Bacterial characteristics, all-cause mortality, and desirability of outcome ranking (DOOR) at 30 days were compared between patients from China, South America, and the US. Findings: Of 991 patients with CRKP, 502 (51%) were infected, and 489 (49%) colonized. CRKP within various regions were genetically similar. Infected patients from the US were more acutely ill as compared to patients from China or South America (median [IQR] Pitt bacteremia score 3 [2, 6] vs. 2 [0, 4], and 2 [0, 4]) and had more comorbid conditions (median [IQR] Charlson comorbidity index 3 [2, 5] vs. 1 [0, 3] and 1 [0, 2]). IPW-adjusted DOOR outcomes were similar in patients from China, South America, and the US. Unadjusted 30-day mortality after CRKP infection was 12% (29/246) in China, vs. 23% (30/130) in the US, vs. 28% (31/109) in South America. Adjusted mortality was similar between China and the US, but higher in South America (vs. China aOR 4·82, 95% CI 2·22–10·50, and vs. US aOR 3·34, 95% CI 1·50–7·47). Patients infected with strains carrying the O2v2 O locus were at lower risk for 30-day mortality vs. other O loci (aOR 0·34, 95% CI 0·15–0·78). Interpretation: The global CRKP epidemic has important regional differences in baseline characteristics of at-risk patients, bacterial characteristics, and clinical outcomes. Research findings from one region may not be generalizable to other regions. Funding: National Institutes of Health
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Ding, L., Shen, S., Chen, J., Tian, Z., Shi, Q., Han, R., Guo, Y., & Hu, F. (2023) · Clinical Microbiology Reviews · doi:10.1128/cmr.00008-23 · Cited by 222
Metadata
- Authors
- Wang, M., Earley, M., Chen, L., Hanson, B. M., Yu, Y., Liu, Z., Salcedo, S., Cober, E., Li, L., Kanj, S. S., Gao, H., Munita, J. M., Ordoñez, K., Weston, G., Satlin, M. J., Valderrama-Beltrán, S. L., Marimuthu, K., Stryjewski, M. E., Komarow, L., Luterbach, C., Marshall, S. H., Rudin, S. D., Manca, C., Paterson, D. L., Reyes, J., Villegas, M. V., Evans, S., Hill, C., Arias, R., Baum, K., Fries, B. C., Doi, Y., Patel, R., Kreiswirth, B. N., Bonomo, R. A., Chambers, H. F., Fowler, V. G., Arias, C. A., van Duin, D., Abbo, L. M., Anderson, D. J., Arias, R., Arias, C. A., Baum, K., Bonomo, R. A., Chambers, H. F., Chen, L., Chew, K. L., Cober, E., Cross, H. R., De, P. P., Desai, S., Dhar, S., Di Castelnuovo, V., Diaz, L., Dinh, A. Q., Doi, Y., Earley, M., Eilertson, B., Evans, B., Evans, S., Fowler Jr, V. G., Fries, B. C., Gao, H., Garcia-Diaz, J., Garner, O. B., Greenwood-Quaintance, K., Hanson, B., Herc, E., Hill, C., Jacob, J. T., Jiang, J., Kalayjian, R. C., Kanj, S. S., Kaye, K. S., Kim, A., Komarow, L., Kreiswirth, B. N., Lauterbach, C., Li, L., Liu, Z., Manca, C., Marimuthu, K., Marshall, S. H., McCarty, T., Munita, J., Ng, O. T., Oñate Gutierrez, J. M., Ordoñez, K., Patel, R., Paterson, D. L., Peleg, A., Reyes, J., Rudin, S. D., Salata, R. A., Salcedo, S., Satlin, M. J., Schmidt-Malan, S., Smitasin, N., Spencer, M., Stryjewski, M., Su, J., Tambyah, P. A., Valderrama, S., van Duin, D., Villegas Botero, M. V., Wang, M., Waters, M., Weston, G., Wong, D., Wortmann, G., Yang, Y., Yu, Y., & Zhang, F.
- Venue
- The Lancet Infectious Diseases
- Publisher
- Elsevier BV
- Published
- 2022-03
- Volume
- 22
- Issue
- 3
- Pages
- 401-412
- ISSN
- 1473-3099 (ISSN-L)
- OpenAlex
- W3213159307
- Cited by
- 363
- References
- 27
- FWCI
- 13.40
- Type
- journal article
- Language
- en
- Open access
- green
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- Wang, M., Earley, M., Chen, L., Hanson, B. M., Yu, Y., Liu, Z., Salcedo, S., Cober, E., Li, L., Kanj, S. S., Gao, H., Munita, J. M., Ordoñez, K., Weston, G., Satlin, M. J., Valderrama-Beltrán, S. L., Marimuthu, K., Stryjewski, M. E., Komarow, L., . . . Zhang, F. (2022). Clinical outcomes and bacterial characteristics of carbapenem-resistant Klebsiella pneumoniae complex among patients from different global regions (CRACKLE-2): a prospective, multicentre, cohort study. The Lancet Infectious Diseases. https://doi.org/10.1016/s1473-3099(21)00399-6
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