Healthcare-associated carbapenem-resistant Klebsiella pneumoniae bloodstream infections: Risk factors, mortality, and antimicrobial susceptibility, 2017–2019

Hsu, Jen-Yu; Chuang, Yu‐Chung; Wang, Jann-Tay; Chen, Yee‐Chun; Hsieh, Szu‐Min

doi:10.1016/j.jfma.2021.04.014

Cited by 19 publications

(10 citation statements)

References 34 publications

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“…In this study, carbapenem use was a risk factor for K . pneumoniae resistance to carbapenems, in consistent with previous studies [ 44 – 46 ]. As mentioned above, our study adopted a case-case-control study and compared with other studies using CSKP as the control group; our results truly reflected the effect of carbapenem use.…”

Section: Discussionsupporting

confidence: 93%

Analysis of risk factors associated with healthcare-associated carbapenem-resistant Klebsiella pneumoniae infection in a large general hospital: a case-case-control study

Huang

Qiao

Deng

et al. 2023

Eur J Clin Microbiol Infect Dis

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Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection is a major public health threat in the world. To inform the prevention and control of CRKP infection in hospitals, this study analyzed the factors associated with CRKP infection and resistance to carbapenems in K . pneumoniae . This case-case-control study was carried out in a large general hospital in China from January 2016 to December 2018, comprising 494 hospitalized patients infected with CRKP (case group 1) and 2429 hospitalized patients infected with carbapenem-susceptible K . pneumoniae (CSKP, case group 2). We selected control groups from hospitalized patients without K . pneumoniae infections for the two case groups separately, with a 1:3 case-control ratio, to analyze the risk factors of the two case groups using the conditional logistic regression. Multivariate analysis showed that the risk factors of CRKP infection were intensive care unit (ICU) admission (odds ratio [OR], 6.85; 95% confidence interval [CI], 4.90–9.58; P < 0.001), respiratory failure (OR, 1.93; 95% CI, 1.34–2.77; P < 0.001), age-adjusted Charlson comorbidity index (aCCI; OR, 1.08; 95% CI, 1.02–1.15; P = 0.007), admission from the Emergency (OR, 1.37; 95% CI, 1.02–1.85; P = 0.036), and imipenem use (OR, 1.80; 95% CI, 1.30–2.49; P < 0.001). Among the aforementioned five risk factors, aCCI (OR, 1.09; 95% CI, 1.06–1.13; P < 0.001) was also identified as a risk factor of CSKP infections in multivariate analysis. The risk factors for resistance to carbapenems in K . pneumoniae were ICU admission, respiratory failure, admission from the Emergency, and imipenem use. Supplementary Information The online version contains supplementary material available at 10.1007/s10096-023-04578-w.

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Section: Discussionsupporting

confidence: 93%

Analysis of risk factors associated with healthcare-associated carbapenem-resistant Klebsiella pneumoniae infection in a large general hospital: a case-case-control study

Huang

Qiao

Deng

et al. 2023

Eur J Clin Microbiol Infect Dis

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“…Although carbapenems are one of the first choice drugs for the treatment of complex urinary tract infections and severe gram-negative bacterial infections, 36 , 37 many previous studies have suggested that carbapenems exposure history is a risk factor for CRKP infection. 38 , 39 Our multivariate analysis supported these hypotheses. Our multivariate analysis also found that exposure to the BLBLIs was an independent risk factor for hospital-acquired CRKP BSI, a correlation rarely mentioned in previous studies.…”

Section: Discussionsupporting

confidence: 72%

Risk Factors for a Hospital-Acquired Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infection: A Five-Year Retrospective Study

Cao¹,

Yue²,

Kong³

et al. 2022

IDR

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Purpose This study aimed to describe trends in Klebsiella pneumoniae (KP) resistance in bloodstream infections (BSI) and to identify risk factors for a hospital-acquired carbapenem-resistant Klebsiella pneumoniae (CRKP) BSI and 28-day mortality from a hospital-acquired KP BSI. Patients and Methods We recorded the results of antimicrobial susceptibility testing of 396 KP-positive blood cultures from January 2016 to December 2020. A total of 277 patients with a KP BSI were included in this study, of which 171 had a hospital-acquired infection and 84 had a hospital-acquired CRKP BSI. Multivariate logistic regression analysis was used to identify risk factors for a hospital-acquired CRKP BSI and 28-day mortality from a hospital-acquired KP BSI. Results The proportion of hospital-acquired infections among KP BSI patients increased from 53.1% in 2016 to 72.8% in 2020. The detection rate of CRKP among KP BSI patients increased from 18.8% in 2016 to 37.7% in 2020. Multivariate logistic regression showed that β-lactam/β-lactamase inhibitor combinations (BLBLIs) exposure ( P = 0.022, OR 2.863), carbapenems exposure ( P = 0.007, OR 3.831) and solid organ transplantation ( P <0.001, OR 19.454) were independent risk factors for a hospital-acquired CRKP BSI. Risk factors for a 28-day mortality from hospital-acquired KP BSI were CRKP BSI ( P =0.009, OR 5.562), septic shock ( P =0.002, OR 4.862), mechanical ventilation>96 hours ( P =0.020, OR 8.765), and platelet counts <100×10 9 /L ( P =0.003, OR 4.464). Conclusion The incidence of hospital-acquired KP BSI continues to rise and the proportion of CRKP BSI is also increasing. We believe that the use of the BLBLIs needs to be carefully evaluated in hospital-acquired infection. Hospital-acquired KP BSI Patients with CRKP BSI, septic shock, mechanical ventilation and deficiency of platelets are more likely to have a poor prognosis.

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“…The mortality of CRKP infection is higher, with a value of 27.3% reported in a previous study [22]. Compared with carbapenem-susceptible K. pneumoniae, CRKP in BSI is associated with significantly worse 2-week survival [23]. Difficult-to-treat Gram-negative BSI and more severe lower respiration tract infection are associated with increased inhospital mortality within one month and appropriate empirical antibiotics related to lower mortality [24].…”

Section: Discussionmentioning

confidence: 94%

Increased Involvement of Klebsiellapneumoniae and Enterococcusfaecium in Healthcare-Associated Infections of Intensive Care Units in Taiwan

Lin

et al. 2021

Healthcare

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Background: Healthcare-associated infections (HAIs) cause increases in length of stay, mortality, and healthcare costs. A previous study conducted in Taiwan obtained similar results to those reported in Korea and Japan in 2015. Changes in microorganisms have been noted in recent years. Understanding the recent condition of HAIs in intensive care units (ICUs) can enable healthcare providers to develop effective infection control protocols to reduce HAIs. Methods: We used the Taiwan Nosocomial Infection Surveillance System to evaluate the incidence densities of HAIs, the proportions of causative pathogens, and the proportions of antimicrobial resistance (AMR). The Poisson regression model was constructed to incidence density, and the chi-square test was used to assess proportion. Results: The incidence density of HAIs decreased 5.7 to 5.4 per 1000 person-days. However, the proportions of Klebsiella pneumoniae and Enterococcus faecium significantly increased. In addition, the proportions of carbapenem-resistant K. pneumoniae and vancomycin-resistant Enterococcus faecium significantly increased over time. Conclusion: Analysis of the microorganisms involved in HAIs in ICUs showed elevated proportions of K. pneumoniae and E. faecium with AMR. Infection control protocols have been implemented for several years and require improvements regarding environmental cleanliness and medical staff prevention.

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Healthcare-associated carbapenem-resistant Klebsiella pneumoniae bloodstream infections: Risk factors, mortality, and antimicrobial susceptibility, 2017–2019

Cited by 19 publications

References 34 publications

Analysis of risk factors associated with healthcare-associated carbapenem-resistant Klebsiella pneumoniae infection in a large general hospital: a case-case-control study

Analysis of risk factors associated with healthcare-associated carbapenem-resistant Klebsiella pneumoniae infection in a large general hospital: a case-case-control study

Risk Factors for a Hospital-Acquired Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infection: A Five-Year Retrospective Study

Increased Involvement of Klebsiellapneumoniae and Enterococcusfaecium in Healthcare-Associated Infections of Intensive Care Units in Taiwan

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