A model for predicting nosocomial carbapenem-resistant Klebsiella pneumoniae infection

Abstract

Mortality associated with infections due to carbapenem-resistant (CR-KP) is high and the infections need to be predicted early. The risk factors for CR-KP infection are heterogeneous. The aim of the present study was to construct a model allowing for the early prediction of CR-KP infection. Nosocomial infections due to were evaluated retrospectively over a 2-year period. The case cohort consisted of 370 inpatients with CR-KP infection. For each case enrolled, two matched controls with no CR-KP infection during their hospitalization were randomly selected. Matching involved month of admission, ward, as well as interval days. The Vitek 2 system was used for identification of isolates and antimicrobial susceptibility testing. General linear model with logistic regression was used to identify possible risk factors. The predicted power of the model was expressed as the area under the receiver-operating characteristic curve. Age, male gender, with cardiovascular disease, hospital stay, recent admission to intensive care unit, indwelling urinary catheter, mechanical ventilation, recent β-lactam-β-lactamase inhibitors, fourth-generation cephalosporins and/or carbapenems therapy were independent risk factors for CR-KP infection. Models predicting CR-KP infection developed by cumulative risk factors exhibited good power, with areas under the receiver-operating characteristic curves of 0.902 [95% confidence interval (CI), 0.883-0.920; P<0.001] and 0.899 (95% CI, 0.877-0.921; P<0.001) after filtering by age (≥70 years). The Yonden index was at the maximum when the cumulative risk factors were ≥3 in the two prediction models. The results show that the prediction model developed in the present study might be useful for controlling infections caused by CR-KP strains.

Risk Factors for Colistin Resistance among Gram-Negative Rods and Klebsiella pneumoniae Isolates

“…The results of our bivariate analysis are largely in line with those of prior similar studies, demonstrating the association with prior infections with carbapenem-resistant organisms ( comorbidities (19,20,22,27), increasing age, male sex, length of stay, and presence of indwelling urinary catheters (22), and prior residence in a nursing home and ICU admission (26). While other models have focused on prior colistin exposure as a risk factor (21,23,24), our multivariate models suggest that exposure to other antibiotics (carbapenems and anti-MRSA agents) may serve as better markers for disease risk.…”

“…Risk factors were similar for all GNRs and for K. pneumoniae, although P values were generally smaller for GNRs due to the larger sample size. Consistent with information previously presented in the literature, risk factors included admission from a nursing home and location in an ICU (26), comorbidity (as measured by the Elixhauser score) (19,22,27), a prior specimen culture positive for a carbapenem-resistant organism (10, 13-15, 21, 23), and prior treatment with colistin (18,21,23,24). Increasing age was associated with Col r K. pneumoniae but not Col r GNRs.…”

“…Infection with colistin-resistant organisms is associated with a substantially increased risk for mortality, and options for treatment are limited (9)(10)(11)(17)(18)(19)(20). Prior studies have typically been relatively small or limited in scope, either following a relatively small number of patients (9,10,17,18,24,26,(30)(31)(32)(33) or focusing on a single organism (16,21,22,27), and none have resulted in a clinically meaningful prediction tool. Our score can be calculated by providers at the time of decision making without the help of a computer.…”

“…Prior literature has identified multiple risk factors for colistin resistance in GNRs, including recent prior hospitalization (17,21,22), prior carbapenem resistance (10, 13-15, 21, 23), prior treatment with colistin (18,21,23,24), exposure to chlorhexidine (25), the presence of multiple comorbidities in the patients (21,22), and increasing age, male sex, length of hospitalization, and the presence of indwelling urinary catheters (22). Other risk factors for the development of MDROs in general included prior residence in a nursing home, hemodialysis, intensive care unit (ICU) admission (26), the presence of a medical comorbidity (19,27), and prior beta-lactam usage and invasive surgery (27).…”

Antibiotic resistance rates among bacterial isolates from infected patients of intensive care unit over the period (2011-2016) in Bursa, Turkey

“…Additionaly, broad-spectrum antimicrobial drugs such as carbapenems are frequently used in ICUs and these drugs are known to contribute for emergence of CR-KP [10][11][12]. In our study, K. pneumoniae was detected increasingly and significantly resistant to imipenem, because our tertiary care hospital admitted cardiology and cardiovascular surgery patients (CVS) from referral hospitals to our ICUs.…”