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Text
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URL Address
<a href="http://doi.org/10.1017/ice.2015.298" target="_blank" rel="noreferrer noopener">http://doi.org/10.1017/ice.2015.298</a>
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Pages
281-288
Issue
3
Volume
37
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Title
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Hospital Readmissions in Patients With Carbapenem-Resistant Klebsiella pneumoniae
Publisher
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Infection Control and Hospital Epidemiology
Date
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2016
2016-03
Subject
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outcomes; epidemiology; therapy; Infectious Diseases; metaanalysis; Environmental & Occupational Health; Public; efficacy; carriage; enterobacteriaceae; outbreak; emergence; tigecycline
Creator
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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
Description
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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.
Identifier
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<a href="http://doi.org/10.1017/ice.2015.298" target="_blank" rel="noreferrer noopener">10.1017/ice.2015.298</a>
Format
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Journal Article or Conference Abstract Publication
2016
Antibacterial Resistance Leadershi
Bonomo R A
carriage
Cober E
Department of Internal Medicine
Doi Y H
efficacy
emergence
Enterobacteriaceae
Environmental & Occupational Health
Epidemiology
Evans S
Fowler V G
Infection control and hospital epidemiology
Infectious Diseases
Journal Article or Conference Abstract Publication
Kalayjian R C
Kaye K S
Messina J A
metaanalysis
NEOMED College of Medicine
outbreak
outcomes
Perez F
Public
Richter S S
Salata R A
Scalera N M
therapy
Tigecycline
van Duin D
Watkins R