OBJECTIVE A prospective observational study was performed to assess the epidemiology and clinical impact of carbapenem-non-susceptible Klebsiella pneumoniae (CNKP) in intensive care units (ICUs) of the national referral hospital in Jakarta, Indonesia. MATERIALS/METHODS Adult patients consecutively hospitalized for > 48 h in two ICUs of the national referral hospital were included from April until October 2013 and from April until August 2014. K. pneumoniae from clinical cultures and standardized screening of rectum and throat on admission, discharge and weekly if hospitalized > 7 days were collected. Environmental niches and healthcare workers (HCWs) were also screened. Susceptibility was determined phenotypically and the presence of carbapenemase genes by PCR. Raman spectroscopy as well as multiple-locus variable number tandem repeat analysis (MLVA) were used for typing. RESULTS Twenty-two out of 412 (5.3%) patients carried CNKP on admission and 37/390 (9.5%) acquired CNKP during ICU stay. The acquisition rate was 24.7/1000 patient-days at risk. One out of 31 (3.2%) environmental isolates was a CNKP. None of the HCWs carried CNKP. Acquisition of CNKP was associated with longer ICU stay (adjusted Hazard Ratio: 2.32 [CI99: 1.35-3.68]). ICU survival was lower among patients with CNKP compared to patients with carbapenem-susceptible K. pneumoniae (aHR 2.57, p = 0.005). Ninety-six of the 100 (96%) CNKP isolates carried a carbapenemase gene, predominantly blaNDM. Raman typing revealed three major clusters among 48 Raman types identified, whereas MLVA distinguished six major clusters among a total of 30 different genotypes. CONCLUSIONS NDM-producing CNKP are introduced into these ICUs and some strains expand clonally among patients and the environment, resulting in endemic CNKP. CNKP acquisition was associated with prolonged ICU stay and may affect ICU survival. TRIAL REGISTRATION The study was registered at Netherlands Trial Register http://www.trialregister.nl. Candidate number: 23527, NTR number: NTR5541, NL number: NL5425 (https://www.trialregister.nl/trial/5424), Retrospectively registered: NTR: 22 December 2015.

中文翻译：

---

印度尼西亚雅加达国家转诊医院重症监护病房中流行的NDM产生性肺炎克雷伯菌的临床影响。

目的进行一项前瞻性观察研究，以评估印度尼西亚雅加达国家转诊医院重症监护病房（ICU）中碳青霉烯类非敏感性肺炎克雷伯菌的流行病学和临床影响。材料/方法自2013年4月至2013年10月以及从2014年4月至2014年8月，在国家转诊医院的两个ICU中连续住院> 48 h的成年患者入院。临床培养的肺炎克雷伯菌和入院，出院时直肠和咽喉的标准化筛查如果住院> 7天，则每周收集一次。还对环境壁ni和医护人员进行了检查。通过表型确定敏感性和碳青霉烯酶基因的存在。使用拉曼光谱法和多位点可变数目串联重复分析（MLVA）进行分型。结果412例患者中有22例（5.3％）入院时携带CNKP，ICU住院期间有37/390例（9.5％）获得CNKP。患病率是24.7 / 1000患者-天。CNKP是31种环境隔离株中的一种（3.2％）。没有任何医护人员携带CNKP。CNKP的获得与ICU住院时间更长有关（风险比调整后：2.32 [CI99：1.35-3.68]）。与患有碳青霉烯易感性肺炎克雷伯菌的患者相比，CNKP患者的ICU存活率较低（aHR 2.57，p = 0.005）。100个（96％）CNKP分离株中有96个带有碳青霉烯酶基因，主要是blaNDM。拉曼分型显示了48种拉曼类型中的三个主要簇，而MLVA在总共30种不同的基因型中区分出6个主要的簇。结论将产生NDM的CNKP引入这些ICU中，并且某些菌株在患者和环境之间克隆繁殖，从而导致地方性CNKP。CNKP的获得与ICU的长期停留有关，并可能影响ICU的生存。试验注册该研究已在荷兰试验注册处注册，网址为http://www.trialregister.nl。候选人编号：23527，NTR编号：NTR5541，NL编号：NL5425（https://www.trialregister.nl/trial/5424），追溯注册：NTR：2015年12月22日。试验注册该研究已在荷兰试验注册处注册，网址为http://www.trialregister.nl。候选人编号：23527，NTR编号：NTR5541，NL编号：NL5425（https://www.trialregister.nl/trial/5424），追溯注册：NTR：2015年12月22日。试验注册该研究已在荷兰试验注册处注册，网址为http://www.trialregister.nl。候选人编号：23527，NTR编号：NTR5541，NL编号：NL5425（https://www.trialregister.nl/trial/5424），追溯注册：NTR：2015年12月22日。