Risk factors and mortality in the Carbapenem-resistant Klebsiella pneumoniae infection: case control study

Abstract

Carbapenem-resistant Klebsiella pneumoniae (CRKP) has been known as a nosocomial pathogen, both for the last 10 years in Turkey and for 20 years worldwide. Due to limited treatment options and high mortality rates, despite improvements in the field of medicine at the present time, CRKP is still a big threat for public health. This study was carried out between the dates of January 2010 and September 2014. Patients ≥18 who were hospitalized for at least 72 h and who also had CRKP growth were included in the study as a case group. In the same period patients, who were hospitalized in the same ward and did not have CRKP growth were selected as the control group. It was determined that no glycopeptides and steroids use nor tracheostomy as protective factors would be employed in terms of non-development of CRKP. Mechanical ventilation, tracheostomy, urinary catheter presence, central venous catheterization, nasogastric tube placement, advanced age, acute renal insufficiency, total parenteral nutrition, carbapenem, glycopeptide, and piperacillin tazobactam were all detected as risk factors in terms of CRKP infection development. As a result, rational usage of antibiotics for preventing infections developing with CRKP should be targeted.

Risk factors for nosocomial carbapenem-resistant Klebsiella infections

“…Foremost, these include: transplantation (organ and stem cell), severe disease, chronic/acute renal failure, neurologic disease, immunosuppressive treatment, and steroid use. [14][15][16][17][19][20][21]25] In our study, chronic renal failure and comorbid diabetes mellitus were found to be risk factors. While one study found systemic steroid use wasn't a risk factor for CRK infection, [26] another study found it was a preventive factor.…”

“…There are studies which report prolonged hospitalization as a risk factor for Klebsiella infection/colonization. [15,16,22,29] Mean infection time of CRK infections in our study was 25.0 (12.75-40.0) days, which was significantly longer compared to the control group.…”

“…[12,13] The control groups of most studies in the literature on the risk factors of CRK infection consist of patients with carbapenem-susceptible Klebsiella infection. [14][15][16][17] To avoid possible bias, the control group of this study was randomly selected among patients without CRK infection.…”

“…Hyle et al [28] reported central venous catheter and Falagas et al [12] reported tracheostomy and nasogastric catheter use were independent risk factors. Akgul et al [16] reported tracheostomy, urinary catheter, central venous catheter, nasogastric catheter, total parenteral nutrition, mechanical ventilation procedures, and emergency operation as risk factors and emphasized that it may be caused by insufficient antisepsis, lack of proper timing of surgical prophylaxis administration, and increased complications due to emergency operation. In our study, use of H2 receptor antagonists, mechanical ventilation, presence of central venous catheter (CVC), nasogastric catheter, tracheostomy and total parenteral nutrition were determined as risk factors for CRK.…”

“…[14][15][16][17]19,20,22,30] However, there are studies that report the contrary. [25,31,32] Liu et al [20] reported quinolone, aminoglycoside, carbapenem, glycopeptide, and antipseudomonal penicillin, Falagas et al [12] and Hussein et al [14] reported carbapenem, Zhang et al [29] carbapenem, glycopeptide, and quinolone, Wu et al [33] carbapenem and glycopeptide, Akgul et al [16] carbapenem, colistin, piperacillin, and tazobactam, and Dizbay et al [18] imipenem and cefoperazone use within three months before infection, and Zarakolu et al [32] reported antibiotic use within three months before infection, especially only imipenem, were risk factors for CRK infections. In our study, correlation between CRK infection and antibiotic use three months prior to infection was also statistically significant.…”