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URL Address
<a href="http://doi.org/10.1093/ofid/ofx216" target="_blank" rel="noreferrer noopener">http://doi.org/10.1093/ofid/ofx216</a>
Pages
ofx216–ofx216
Issue
4
Volume
4
Dublin Core
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Title
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Carbapenem-Resistant Enterobacteriaceae Infections in Patients on Renal Replacement Therapy.
Publisher
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Open forum infectious diseases
Date
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2017
1905-07
Subject
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carbapenem-resistant Enterobacteriaceae; Klebsiella pneumoniae; mortality; renal failure; renal replacement therapy
Creator
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Eilertson Brandon; Cober Eric; Richter Sandra S; Perez Federico; Salata Robert A; Kalayjian Robert C; Watkins Richard R; Doi Yohei; Kaye Keith S; Evans Scott; Fowler Vance G Jr; Bonomo Robert A; DeHovitz Jack; Kreiswirth Barry; van Duin David
Description
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Background: Patients on chronic intermittent renal replacement therapy (RRT) are at risk for infection with carbapenem-resistant Enterobacteriaceae (CRE). However, the impact of RRT on outcomes after CRE infections remains to be defined. Here we perform a comparison of outcomes for CRE-infected patients with preserved renal function compared with CRE-infected patients on RRT. Methods: Cases and controls were defined from a prospective cohort of CRE-infected patients from the Consortium on Resistance against Carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE). Cases were defined as CRE-infected patients on RRT at hospital admission, while controls were defined as CRE-infected patients with serum creatinine \textless2 mg/dL and not receiving RRT at admission. Risk factors for 28-day in-hospital mortality were assessed using multivariable logistic regression. An ordinal ranking of outcomes by desirability analysis was performed. Results: Patients on RRT were more likely to have diabetes mellitus and cardiac disease than controls. Urinary sources of infection were less common in the RRT group. In RRT patients, 28-day in-hospital mortality was increased as compared with controls: 22/71 (31%) vs 33/295 (11%). RRT remained significantly associated with 28-day in-hospital mortality after adjustment for source of infection, prehospitalization origin, and severity of illness (adjusted odds ratio, 2.27; 95% confidence interval [CI], 1.09-4.68; P = .03). Using univariable desirability of outcome ranking analysis, RRT status was associated with a 68% (95% CI, 61%-74%) chance of a worse disposition outcome. Conclusions: Chronic RRT in CRE-infected patients is associated with increased in-hospital mortality and worse disposition outcomes at 28 days.
Identifier
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<a href="http://doi.org/10.1093/ofid/ofx216" target="_blank" rel="noreferrer noopener">10.1093/ofid/ofx216</a>
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2017
Bonomo Robert A
carbapenem-resistant Enterobacteriaceae
Cober Eric
DeHovitz Jack
Department of Internal Medicine
Doi Yohei
Eilertson Brandon
Evans Scott
Fowler Vance G Jr
Kalayjian Robert C
Kaye Keith S
Klebsiella pneumoniae
Kreiswirth Barry
Mortality
NEOMED College of Medicine
Open forum infectious diseases
Perez Federico
Renal failure
renal replacement therapy
Richter Sandra S
Salata Robert A
van Duin David
Watkins Richard R