Antibiotic use and the risk of carbapenem-resistant extended-spectrum- -lactamase-producing Klebsiella pneumoniae infection in hospitalized patients: results of a double case-control study

Abstract

This study highlights the major role of treatment and duration of treatment with β-lactam/β-lactamase inhibitor combinations and combinations of carbapenems with fluoroquinolones. Clinicians should counterweight the potential benefits of administering these antibiotics against the increased risk of ESBL-CRKP infection.

A retrospective study of risk factors for carbapenem-resistant Klebsiella pneumoniae acquisition among ICU patients

“…In accordance with previous prospective or retrospective studies, our results confirmed that prior exposure to carbapenems was an independent risk factor for CRKP infection [12,20,21]. However, in contrast with some other studies [18,[20][21][22], we did not find that the use of cephalosporins, antipseudomonal penicillins, and fluoroquinolones was associated with increased CRKP infection; thus, the association of CRKP infection with fluoroquinolones remains controversial [8,12,17,21,22]. Our finding may be related to the high rate of exposure to -lactam/-lactamase inhibitor combinations during the patient's ICU stay and the scarce use of fluoroquinolones, aminoglycosides, or other antibiotics due to their side effects, pharmacological properties, administration issues, and efficacy limitations [7].…”

“…The relationship between prior antimicrobial use and antibiotic-resistant infection may not be linear (i.e., the risk may not increase at a constant rate with increasing antimicrobial exposure) [24]. The finding of Kritsotakis et al [18] that prior antibiotic exposures as continuous variables revealed dosedependent effects of antibiotics on the risk of extendedspectrum -lactamase (ESBL) CRKP infection, which was seen to increase with increasing duration of prior treatment with -lactam/-lactamase inhibitor combinations, fluoroquinolones, and carbapenems. A recent prospective study found that the duration of colistin, which is currently used as empirical treatment prior to CRKP isolation, was independently associated with increased frequency of CRKP infection (p = 0.025) [14].…”

“…Several previous studies have assessed risk factors of CRKP infections among hospitalized patients, and ICU stay was found to be an independent risk factor [8,10,12,17,18]. ICUs are considered as the main source for multidrug-resistant bacteria spread.…”

“…Whether or not the prior use of antibiotics is associated with CRKP infection is still controversial. Some studies found that antibiotic exposure was a risk factor for CRKP acquisition [8,12,17,18]. In contrast, other studies found that CRKP acquisition was not associated with prior antibiotic therapy [9,10,19].…”

Prophylactic ciprofloxacin for prostate biopsy: a losing bet?

“…We have demon strated in our population that erta penem prophylaxis does not drive carbapenem resist ance, and several studies suggest that the use of fluoroquinolones poses a greater risk [8][9][10] . We acknowledge that in populations with higher levels of carbapenem resistance erta penem prophylaxis might carry an unknown risk, but we argue that the 'ciprofloxacin gamble' is high risk, has already failed, and alternative options must be sought.…”