Bloodstream Infections Caused by Metallo-β-Lactamase/Klebsiella pneumoniae Carbapenemase–Producing K. pneumoniae among Intensive Care Unit Patients in Greece: Risk Factors for Infection and Impact of Type of Resistance on Outcomes

Mouloudi, Eleni; Protonotariou, Efthimia; Zagorianou, Alexia; Iosifidis, Εlias; Karapanagiotou, A.; Giasnetsova, T.; Tsioka, Agoritsa; Roilides, Emmanuel; Sofianou, Danai; Gritsi-Gerogianni, N.

doi:10.1086/657135

Cited by 170 publications

(151 citation statements)

References 25 publications

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“…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]. These differences may be related to the high rate of antibiotic exposure during ICU stay among the total study population, making it very difficult to assess the impact of antibiotic exposure [17].…”

Section: Discussionmentioning

confidence: 96%

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

Ping

et al. 2016

J Infect Dev Ctries

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Introduction: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is rapidly emerging as a life-threatening nosocomial infection. In this study, we aim to identify risk factors, especially antibiotic use, for CRKP infection among intensive care unit (ICU) patients. Methodology: This was a matched case-control study of a 67-bed ICU in a tertiary care teaching hospital from 1 January 2011 through 30 June 2013. The control cases were selected among the patients with carbapenem-susceptible Klebsiella pneumoniae (CSKP) and were matched with CRKP cases for year of ICU admission and site of infection. The clinical outcomes and antibiotic treatments were analyzed. Results: One hundred and thirty patients were included in the study (65 cases and 65 controls). Bivariable analysis showed that age of patients (p = 0.044), number of antibiotic groups (p = 0.001), and exposure to carbapenems (p < 0.001) were associated with CRKP infection. Using multivariate analysis adjusted for age, prior hospitalization, number of antibiotic groups, and previous exposure to carbapenems, previous carbapenem exposure (p < 0.001) was identified as an independent risk factor for CRKP infection. Conclusions: These data suggest that exposure to carbapenems is an independent risk factor for CRKP infection. Patients with this clinical factor should be targeted for interventions to reduce the subsequent risk of infection.

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Section: Discussionmentioning

confidence: 96%

“…Especially for bloodstream infection (BSI) with CRKP, it is clear that the mortality from BSI caused by CRKP is increased compared to BSI caused by susceptible organisms [19,25,26]. In addition, finding CRKP in the bloodstream is associated with worse outcomes compared to isolation from other sites.…”

Section: Discussionmentioning

confidence: 99%

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

Ping

et al. 2016

J Infect Dev Ctries

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“…Mouloudi et al [45] Double case -control study 59 BSI K. pneumoniae/carbapenem resistance Positive association between KPC producing K. pneumoniae and mortality Michalopoulos et al [46] Retrospective casecontrol study The additional effect of the most common antimicrobial resistance patterns on mortality is comparatively low Tabah et al [48] Prospective multicentre cohort study Resistance not associated with mortality…”

Section: Bsi a Baumannii/carbapenem Resistance No Association With Mmentioning

confidence: 99%

Association between infections caused by multidrug-resistant gram-negative bacteria and mortality in critically ill patients

Paramythiotou

Routsi

2016

WJCCM

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The incidence of gram-negative multidrug-resistant (MDR) bacterial pathogens is increasing in hospitals and particularly in the intensive care unit (ICU) setting. The clinical consequences of infections caused by MDR pathogens remain controversial. The purpose of this review is to summarize the available data concerning the impact of these infections on mortality in ICU patients. Twenty-four studies, conducted exclusively in ICU patients, were identified through PubMed search over the years 2000-2015. Bloodstream infection was the only infection examined in eight studies, respiratory infections in four and variable infections in others. Comparative data on the appropriateness of empirical antibiotic treatment were provided by only seven studies. In ten studies the presence of antimicrobial resistance was not associated with increased mortality; on the contrary, in other studies a significant impact of antibiotic resistance on mortality was found, though, sometimes, mediated by inappropriate antimicrobial treatment. Therefore, a direct association between infections due to gram-negative MDR bacteria and mortality in ICU patients cannot be confirmed. Sample size, presence of multiple confounders and other methodological issues may influence the results. These data support the need for further studies to elucidate the real impact of infections caused by resistant bacteria in ICU patients.

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“…Mortality rates of about 41-80% have been reported in literature when infection occurs. 9,10 Given the high degree of antibiotic resistance by these bacteria, therapeutic options are indeed very limited, including variable combinations of aminoglycosides, tigecycline, colistin and fosfomycin. There is much debate in literature about the possible use of carbapenems at high dosage or in combination therapy when K. pneumoniae minimum inhibitory concentrations for imipenem are <4 mg/L.…”

Section: Epidemiologymentioning

confidence: 99%

Carbapenemase-producing Klebsiella pneumoniae in elderly frail patients admitted to medical wards

2014

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Carbapenemase-producing Klebsiella pneumoniae (CPKP) is rapidly emerging as a leading nosocomial infection in many countries, especially in Italy where it is considered endemic. In this paper we briefly summarize the main characteristics of this outbreak, focusing on its recent spread to elderly frail patients admitted to internal medicine and geriatric wards. Severity of disease, clinical complexity and a large number of comorbidities seem to be major risk factors in clinical practice, although scientific evidence is still lacking, since until now studies have been carried out mainly in intensive care settings. We also discuss the possible role of gut microbiota in CPKP colonization onset and the possible role of pre-probiotics in promoting eradication.

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Bloodstream Infections Caused by Metallo-β-Lactamase/Klebsiella pneumoniae Carbapenemase–Producing K. pneumoniae among Intensive Care Unit Patients in Greece: Risk Factors for Infection and Impact of Type of Resistance on Outcomes

Abstract: BSIs due to KPC-producing K. pneumoniae resulted in significantly increased mortality. The accurate and rapid detection of these pathogens is necessary for therapeutic considerations and for the implementation of infection control measures to contain them.

Cited by 170 publications

References 25 publications

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

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

Association between infections caused by multidrug-resistant gram-negative bacteria and mortality in critically ill patients

Carbapenemase-producing Klebsiella pneumoniae in elderly frail patients admitted to medical wards

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