Carbapenem-Resistant Enterobacteriaceae Infections in Patients on Renal Replacement Therapy.

Carbapenem-Resistant Enterobacteriaceae Infections in Patients on Renal Replacement Therapy.

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

Open forum infectious diseases

2017

1905-07

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.

carbapenem-resistant Enterobacteriaceae; Klebsiella pneumoniae; mortality; renal failure; renal replacement therapy

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

ofx216–ofx216

4

4