Clinical features and molecular epidemiology of plasmid-mediated DHA-type AmpC β-lactamase-producing Klebsiella pneumoniae blood culture isolates, Hong Kong

Knowledge of risk factors and clinical characteristics of bacteraemia caused by plasmid-mediated AmpC β-lactamase (pAmpC)-producing Klebsiella pneumoniae (pAmpC-Kp) is not well described. This was a retrospective cohort study of patients with K. pneumoniae bacteraemia in three Hong Kong regional hospitals. Demographic and clinical data were retrieved from medical records. Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were performed for molecular epidemiology. A total of 109 patients were included, divided into four groups: bacteraemia due to K. pneumoniae with (i) DHA-type pAmpC (n = 23), (ii) extended-spectrum β-lactamase (ESBL) (n = 37), (iii) DHA-type pAmpC + ESBL (n = 26) and (iv) controls (n = 23). Nursing home residence was independently associated with pAmpC-Kp bacteraemia compared with ESBL-Kp bacteraemia [adjusted odds ratio (aOR) = 7.13, 95% confidence interval (CI) 1.36-37.54] and controls (aOR = 41.47, 95% CI 4.55-377.75). Compared with controls, patients with pAmpC-Kp bacteraemia also suffered from more severe illness [median Acute Physiology and Chronic Health Evaluation (APACHE) II scores 16 and 25, respectively; P = 0.006]. Importantly, the pAmpC group received discordant empirical antimicrobial therapy more frequently (OR = 24.00, 95% CI 5.01-114.97), resulting in higher 7-day mortality (OR = 20.17, 95% CI 2.32-175.67) and 30-day mortality (OR 4.68, 95% CI 1.29-16.98). PFGE detected six pulsotypes, corresponding to the predominant sequence type 11. Severity of illness and mortality of patients with bacteraemia caused by pAmpC-Kp were high. Patients who are nursing home residents presenting nosocomial sepsis should be treated with broad-spectrum antimicrobials.