Predictors of Carbapenem-Resistant Klebsiella pneumoniae Acquisition among Hospitalized Adults and Effect of Acquisition on Mortality

Abstract

Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an emerging nosocomial pathogen. Little is known about its risk factors or mortality. We performed a case-case-control study to assess the risks for CRKP isolation and a retrospective cohort study to assess mortality in three groups of hospitalized adults: (i) patients from whom CRKP was isolated, (ii) patients from whom carbapenem-susceptible Klebsiella spp. (CSKS) were isolated, and (iii) controls from whom no Klebsiella spp. were isolated. After adjustment for length of stay (LOS), the demographics, comorbidities, and exposures of each case group were compared with those of the controls. Significant covariates were incorporated into LOS-adjusted multivariable models. In the mortality study, we evaluated the effect of CRKP on in-hospital death. There were 48 patients with CRKP isolation ( After adjustment for the severity of illness, CRKP isolation remained predictive of death, albeit with a lower OR (for the CRKP group versus the CSKS group, OR, 3.9; 95% CI, 1.1 to 13.6; and P ‫؍‬ 0.03; for the CRKP group versus the controls, OR, 5.0; 95% CI, 1.7 to 14.8; and P ‫؍‬ 0.004). CRKP affects patients with poor functional status, an ICU stay, and antibiotic exposure and is an independent predictor of death.

Risk Factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Acquisition Among Contacts of Newly Diagnosed CP-CRE Patients

“…3,4,9,10,[26][27][28] These discrepancies might be related at least in part to different definitions of antimicrobial exposure and the possibility of uncontrolled confounders in retrospective studies. 29 In our study, the small number of patients who received each specific class of antibiotic limited our ability to find statistically significant associations.…”

“…1,2 Infections by these strains have also been associated with poor clinical outcomes. [3][4][5] Since they were originally reported in nosocomial outbreaks in the northeastern United States more than a decade ago, these strains have disseminated rapidly to become endemic pathogens in North America, and they are also widespread in Europe, Latin America, and Asia. 6 Israel experienced a large outbreak beginning in 2006, and efforts to contain this outbreak are continuing.…”

“…Several case-control studies have identified healthcare-associated factors as predictors for isolation of CP-CRE among hospitalized patients. 3,9,10 Molecular studies have demonstrated how clonal expansion and horizontal plasmid dissemination, either within the same species or, rarely, between species, underlie the spread of these multidrug-resistant pathogens. [11][12][13][14] Strict contact isolation, physical separation of carriers from noncarriers, and use of dedicated staff are key components in containing CP-CRE in acute care hospitals.…”

Hygienemaßnahmen bei Infektionen oder Besiedlung mit multiresistenten gramnegativen Stäbchen

“…[191]. In entsprechenden Studien konnte eine vorhergehende Antibiotikatherapie bei Infektionen durch K. pneumoniae mit ESBL [192,193] oder CarbapenemResistenz [189,194] als unabhängiger Risikofaktor identifiziert werden. Eine andere Studie konnte zwar nicht eine Antibiotikatherapie per se als signifikanten Risikofaktor für Carbapenem-resistente K. pneumoniae identifizieren, jedoch die Anzahl der vorher verabreichten Antibiotika [187].…”

“…Komorbiditäten wurden in etlichen Studien als signifikante Risikofaktoren gefunden [183,186,[188][189][190]. Daneben fanden sich eine kürzliche Organtransplantation [198], vorhergehende Operationen [185,190] oder nicht operative Eingriffe [189], zentrale Gefäßzugän-ge [183,187,189,198], mechanische Beatmung [185,190,198], Magensonden [187,190], Harnwegskatheter [187,189], Wunden [187], Aufenthalt auf Intensivstationen [183,185,187,189,198], vorhergehende Hospitalisierung [189] und die Dauer des Krankenhausaufenthaltes [183,187,190,198] [140]. Auf 16 deutschen Intensivstationen entwickelten 10 % der Patienten, die mit 3.…”