Risk factors for carbapenem-resistant Klebsiella pneumoniae bloodstream infection among rectal carriers: a prospective observational multicentre study

Abstract

Knowledge of carbapenem-resistant Klebsiella pneumoniae (CR-KP) colonization is important to prevent nosocomial spread but also to start prompt adequate antibiotic therapy in patients with suspicion of infection. However, few studies have examined the incidence and risk factors for CR-KP bloodstream infection (BSI) among rectal carriers. To identify risk factors for CR-KP BSI among carriers, we performed a multicentre prospective matched case-control study of all adult CR-KP rectal carriers hospitalized in five tertiary teaching hospitals in Italy over a 2-year period. Carriers who developed CR-KP BSI were compared with those who did not develop subsequent BSI. Overall, 143 CR-KP BSIs were compared with 572 controls without a documented infection during their hospitalization. Multivariate analysis revealed that admission to the Intensive Care Unit (ICU) (OR, 1.65; 95% CI, 1.05-2.59; p 0.03), abdominal invasive procedure (OR, 1.87; 95% CI, 1.16-3.04; p 0.01), chemotherapy/radiation therapy (OR, 3.07; 95% CI, 1.78-5.29; p<0.0001), and number of additional colonization sites (OR, 3.37 per site; 95% CI, 2.56-4.43; p <0.0001) were independent risk factors for CR-KP BSI development among CR-KP rectal carriers. A CR-KP BSI risk score ranging from 0 to 28 was developed based on these four independent variables. At a cut-off of ≥2 the model exhibited a sensitivity, specificity, positive predictive value and negative predictive value of 93%, 42%, 29% and 93%, respectively. Colonization at multiple sites with CR-KP was the strongest predictor of BSI development in our large cohort of CR-KP rectal carriers.

Emergence of Infections due to a Polymyxin B–Resistant KPC-2-Producing Klebsiella pneumoniae in Critically Ill Patients: What Is the Role of a Previous Colonization?

“…As in ours, only a few studies have addressed progression to infection among colonized patients with CPE, using the recovery from clinical sites as a marker for infection. [6][7][8] Interestingly, our results were similar to these studies, mainly in relation to the incidence rate of infections among colonized patients and the predominance of KPC-2-KP among the CPE isolates. On the other hand, in these studies, no data on polymyxin B resistance was reported.…”

Bloodstream infections in neutropenic cancer patients: A practical update

“…For carbapenem-resistant Enterobacteriaceae, rectal colonization by resistant pathogens was followed by BSIs in 45% of neutropenic patients. 55 The association between colonization and subsequent infection has been reported for many MDR bacteria, such as VRE, ESBL-producing Enterobacteriaceae, P. aeruginosa, S. maltophilia and carbapenem or colistin resistant K. pneumoniae. 115,116 Therefore, decolonization before the onset of neutropenia seems appealing in case of carbapenem-resistant bacteria, but very few data on the efficacy of this approach exist in this setting.…”

“…34 Of note, rectal colonization by carbapenem-resistant K. pneumoniae was followed by BSIs in 45% of neutropenic patients. 55 Also non-fermenting GN rods harbor frequently this type of resistance. In fact, P. aeruginosa, which is responsible for 15-20% of GN infections, 56 might be frequently carbapenem-resistant in some regions, as demonstrated in an Italian multicenter cohort, where 71% of strains were MDR.…”

Management of carbapenem resistant Klebsiella pneumoniae infections in stem cell transplant recipients: an Italian multidisciplinary consensus statement

“…3,4,7,8 In a recent survey in a tertiary teaching Italian hospital, when compared to internal medicine patients (4.3/1000 colonization days), the highest incidence of CRKp infections among colonized patients was observed in hematology (26.3; P=0.04) and ICU (13.1; P=0.0004), followed by surgery (8.6; P=0.14), transplant (7.4; P=0.34), and long-term care (4.7; P=0.99). CRKp attributable mortality was highest in hematology (75%) followed by ICU (11%), transplant (7%), long term care (5%), internal medicine and surgery (both 2%).…”

“…Corrado Girmenia, 1 Claudio Viscoli, 2 Alfonso Piciocchi, 3 Laura Cudillo, 4 Stefano Botti, 5 Antonio Errico, 6 Loredana Sarmati, 7 Fabio Ciceri, 8 Franco Locatelli, 9 Maddalena Giannella, 10 Matteo Bassetti, 11 Carlo Tascini, 12 Letizia Lombardini, 6,13 Ignazio Majolino, 14 Claudio Farina, 15 Francesco Luzzaro, 16 Gian Maria Rossolini, [17][18][19] and …”