Risk factors for infections due to carbapenem-resistantKlebsiella pneumoniaeafter open heart surgery

Abstract

In our cohort, CR-Kp colonization was an important predictor of CR-Kp infection after open heart surgery. CR-Kp infection after surgery significantly affected survival. Preventing colonization is conceivably the most effective current strategy to reduce the impact of CR-Kp.

Prevalence, molecular epidemiology and intra-hospital acquisition of Klebsiella pneumoniae strains producing carbapenemases in an Italian teaching hospital from January 2015 to September 2016

“…Year 2015: clinical samples ST-512 (n) ST-745 2 (n) ST-307 (n) ST-554 (n) ST-15 (n) ST-16 (n) ST-101 (n) ST-11 (n) Other ST and samples with 2 isolates at time MD 8 8 2 18 4 1 2 1 1 Total 4 10 11 6 26 4 3 3 1 1 3 Year 2016: clinical samples ST-258 (n) ST-512 (n) ST-745 2 (n) ST-307 (n) ST-554 (n) ST-16 (n) ST-101 (n) ST-37 (n) ST-45 (n) Year 2016: surveillance rectal swabs colonized by CPKP at admission can be extremely different, ranging from 50% to 6.1% (Di Carlo et al, 2013;Salsano et al, 2016). Furthermore, probably surgical patients underwent invasive procedures (including urinary catheterization and endoscopy procedures) more frequently with respect to patients admitted to MD and in a healthcare environment different from that of ICD, with a higher risk of person to person transmission.…”

Management of KPC-producing Klebsiella pneumoniae infections

“…Other risk factors for KPC-KP BSI included intensive care unit admission, abdominal invasive procedures, chemotherapy or radiotherapy, and previous BSI [107,109]. In a study including patients undergoing open heart surgery, colonization was the most important risk factor for KPC-KP infection [110]. In a prospective cohort study of adult patients undergoing liver transplantation, KPC-KP infection rates among patients noncolonized, colonized at liver transplantation and colonized after liver transplantation were 2%, 18.2% and 46.7%, respectively [107].…”

Risk Factors for Candidemia After Open Heart Surgery: Results From a Multicenter Case–Control Study

“…Indeed, candidemia mostly developed late during ICU stay (and thus the length of postoperative ICU stay was inherently long, also in matched controls), a fact that is in line with the well-known role of prolonged hospital stay as a general predictor of candidemia [ 5 , 6 , 20 , 23 , 24 ]. Overall, this may suggest that CPB time is not helpful for discriminating the risk of candidemia (absolutely or vs that of bacterial BSI [ 35 ]) in cardiac surgery patients with prolonged ICU stay, that is, in those who usually are the most likely to develop candidemia because they already express classical, non-surgery-related risk factors. For example, our results confirm that the previous administration of broad-spectrum antibiotics is an important risk factor for candidemia in cardiac surgery patients, in line with the results of previous studies conducted in more general populations [ 20 , 22 , 23 , 36–38 ], and potentially explained by the disruptive effect that previous broad-spectrum antibiotics may have on the human microbiota with consequent increased risk of Candida translocation [ 39 ].…”