Spectrum of excess mortality due to carbapenem-resistant Klebsiella pneumoniae infections.
*beta-Lactam Resistance; 80 and over; Aged; Bacteremia/microbiology/mortality; Bacterial/microbiology/mortality; carbapenem-resistant Enterobacteriaceae; epidemiology; Female; Humans; Klebsiella Infections/*microbiology/*mortality; Klebsiella pneumoniae; Klebsiella pneumoniae/*drug effects/isolation & purification; Longitudinal Studies; Male; Middle Aged; mortality; Mortality; pneumonia; Pneumonia; Prospective Studies; Survival Analysis; Urinary Tract Infections/microbiology/mortality
Patients infected or colonized with carbapenem-resistant Klebsiella pneumoniae (CRKp) are often chronically and acutely ill, which results in substantial mortality unrelated to infection. Therefore, estimating excess mortality due to CRKp infections is challenging. The Consortium on Resistance against Carbapenems in K. pneumoniae (CRACKLE) is a prospective multicenter study. Here, patients in CRACKLE were evaluated at the time of their first CRKp bloodstream infection (BSI), pneumonia or urinary tract infection (UTI). A control cohort of patients with CRKp urinary colonization without CRKp infection was constructed. Excess hospital mortality was defined as mortality in cases after subtracting mortality in controls. In addition, the adjusted hazard ratios (aHR) for time-to-hospital-mortality at 30 days associated with infection compared with colonization were calculated in Cox proportional hazard models. In the study period, 260 patients with CRKp infections were included in the BSI (90 patients), pneumonia (49 patients) and UTI (121 patients) groups, who were compared with 223 controls. All-cause hospital mortality in controls was 12%. Excess hospital mortality was 27% in both patients with BSI and those with pneumonia. Excess hospital mortality was not observed in patients with UTI. In multivariable analyses, BSI and pneumonia compared with controls were associated with aHR of 2.59 (95% CI 1.52-4.50, p \textless0.001) and 3.44 (95% CI 1.80-6.48, p \textless0.001), respectively. In conclusion, in patients with CRKp infection, pneumonia is associated with the highest excess hospital mortality. Patients with BSI have slightly lower excess hospital mortality rates, whereas excess hospital mortality was not observed in hospitalized patients with UTI.
Hauck C; Cober E; Richter S S; Perez F; Salata R A; Kalayjian R C; Watkins R R; Scalera N M; Doi Y; Kaye K S; Evans S; Fowler V G Jr; Bonomo R A; van Duin D
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
2016
2016-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.cmi.2016.01.023" target="_blank" rel="noreferrer noopener">10.1016/j.cmi.2016.01.023</a>
Hospital Readmissions in Patients With Carbapenem-Resistant Klebsiella pneumoniae
outcomes; epidemiology; therapy; Infectious Diseases; metaanalysis; Environmental & Occupational Health; Public; efficacy; carriage; enterobacteriaceae; outbreak; emergence; tigecycline
BACKGROUND. Various transmission routes contribute to spread of carbapenem-resistant Klebsiella pneumoniae (CRKP) in hospitalized patients. Patients with readmissions during which CRKP is again isolated ("CRKP readmission") potentially contribute to transmission of CRKP. OBJECTIVE. To evaluate CRKP readmissions in the Consortium on Resistance against Carbapenems in K. pneumoniae (CRaCKLe). DESIGN. Cohort study from December 24, 2011, through July 1, 2013. SETTING. Multicenter consortium of acute care hospitals in the Great Lakes region. PATIENTS. All patients who were discharged alive during the study period were included. Each patient was included only once at the time of the first CRKP-positive culture. METHODS. All readmissions within 90 days of discharge from the index hospitalization during which CRKP was again found were analyzed. Risk factors for CRKP readmission were evaluated in multivariable models. RESULTS. Fifty-six (20%) of 287 patients who were discharged alive had a CRKP readmission. History of malignancy was associated with CRKP readmission (adjusted odds ratio [adjusted OR], 3.00 [95% CI, 1.32-6.65], P<.01). During the index hospitalization, 160 patients (56%) received antibiotic treatment against CRKP; the choice of regimen was associated with CRKP readmission (P=.02). Receipt of tigecycline-based therapy (adjusted OR, 5.13 [95% CI, 1.72-17.44], using aminoglycoside-based therapy as a reference in those treated with anti-CRKP antibiotics) was associated with CRKP readmission. CONCLUSION. Hospitalized patients with CRKP specifically those with a history of malignancy are at high risk of readmission with recurrent CRKP infection or colonization. Treatment during the index hospitalization with a tigecycline-based regimen increases this risk.
Messina J A; Cober E; Richter S S; Perez F; Salata R A; Kalayjian R C; Watkins R; Scalera N M; Doi Y H; Kaye K S; Evans S; Bonomo R A; Fowler V G; van Duin D; Antibacterial Resistance Leadershi
Infection Control and Hospital Epidemiology
2016
2016-03
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1017/ice.2015.298" target="_blank" rel="noreferrer noopener">10.1017/ice.2015.298</a>