Patient risk factors for outer membrane permeability and KPC-producing carbapenem-resistant Klebsiella pneumoniae isolation: results of a double case–control study

Infection ◽  
2012 ◽  
Vol 41 (1) ◽  
pp. 61-67 ◽  
Author(s):  
G. B. Orsi ◽  
A. Bencardino ◽  
A. Vena ◽  
A. Carattoli ◽  
C. Venditti ◽  
...  
2008 ◽  
Vol 29 (12) ◽  
pp. 1099-1106 ◽  
Author(s):  
Gopi Patel ◽  
Shirish Huprikar ◽  
Stephanie H. Factor ◽  
Stephen G. Jenkins ◽  
David P. Calfee

Background.Carbapenem-resistant Klebsiella pneumoniae is an emerging healthcare-associated pathogen.Objective.To describe the epidemiology of and clinical outcomes associated with carbapenem-resistant K. pneumoniae infection and to identify risk factors associated with mortality among patients with this type of infection.Setting.Mount Sinai Hospital, a 1,171-bed tertiary care teaching hospital in New York City.Design.Two matched case-control studies.Methods.In the first matched case-control study, case patients with carbapenem-resistant K. pneumoniae infection were compared with control patients with carbapenem-susceptible K. pneumoniae infection. In the second case-control study, patients who survived carbapenem-resistant K. pneumoniae infection were compared with those who did not survive, to identify risk factors associated with mortality among patients with carbapenem-resistant K. pneumoniae infection.Results.There were 99 case patients and 99 control patients identified. Carbapenem-resistant K. pneumoniae infection was independently associated with recent organ or stem-cell transplantation (P = .008), receipt of mechanical ventilation (P = .04), longer length of stay before infection (P = .01), and exposure to cephalosporins (P = .02) and carbapenems (P < .001). Case patients were more likely than control patients to die during hospitalization (48% vs 20%; P < .001) and to die from infection (38% vs 12%; P < .001). Removal of the focus of infection (ie, debridement) was independently associated with patient survival (P = .002). The timely administration of antibiotics with in vitro activity against carbapenem-resistant K. pneumoniae was not associated with patient survival.Conclusions.Carbapenem-resistant K. pneumoniae infection is associated with numerous healthcare-related risk factors and with high mortality. The mortality rate associated with carbapenem-resistant K. pneumoniae infection and the limited antimicrobial options for treatment of carbapenem-resistant K. pneumoniae infection highlight the need for improved detection of carbapenem-resistant K. pneumoniae infection, identification of effective preventive measures, and development of novel agents with reliable clinical efficacy against carbapenem-resistant K. pneumoniae.


Infection ◽  
2012 ◽  
Vol 41 (2) ◽  
pp. 503-509 ◽  
Author(s):  
S. Shilo ◽  
M. V. Assous ◽  
T. Lachish ◽  
P. Kopuit ◽  
T. Bdolah-Abram ◽  
...  

2014 ◽  
Vol 20 (5) ◽  
pp. 293-297 ◽  
Author(s):  
Diamantis P. Kofteridis ◽  
Antonis Valachis ◽  
Dimitra Dimopoulou ◽  
Sofia Maraki ◽  
Athanasia Christidou ◽  
...  

2014 ◽  
pp. 54-60 ◽  
Author(s):  
Viviana Gómez Rueda ◽  
John Jairo Zuleta Tobón

Objetive: To evaluate the association between quinolone exposure and the emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) and to estimate CRKP-specific mortality. Methods: Case-case-control study implemented in a tertiary care institution. Three groups of patients were analyzed: 61 consecutive cases of infection with CRKP (Group I); 61 randomly chosen cases of patients infected with carbapenem-sensitive Klebsiella pneumoniae (CSKP; Group II); and 122 randomly chosen controls without CRKP or CSKP infection. Matching was based on the length of stay in intensive care unit and the date of bacterial isolation. An active search was performed for patients with CRKP and CSKP infection, and prospective cases were included in the study. We compared the results for Groups I and II against those for the controls by using two conditional logistic regression analyses that included infection as the dependent variable and controlled for time at risk and co-morbidities. Results: Exposure to quinolones was not associated with CRKP infection: no association was found in the analysis of CRKP with the controls (OR= 1.7; 95% CI: 0.2-6.5) or in the analysis of CSKP against the controls (OR= 0.6; 95% CI: 0.2-1.6). Use of carbapenems (OR = 3.3; 95% CI: 1.2-9.3) and colonization with CRKP (OR = 3.3; 95% IC: 1.2-9.3) were specific risk factors for infection with CRKP. Mortality associated with CRKP was 61.3%. Conclusion: No association was found between exposure to quinolones and infection with CRKP; however, colonization by CRKP and use of carbapenems are risk factors for infection with CRKP.


2016 ◽  
Vol 110 (7-8) ◽  
pp. 321-325 ◽  
Author(s):  
Fethiye Akgul ◽  
Ilkay Bozkurt ◽  
Mustafa Sunbul ◽  
Saban Esen ◽  
Hakan Leblebicioglu

2007 ◽  
Vol 60 (5) ◽  
pp. 1124-1130 ◽  
Author(s):  
M. E. Falagas ◽  
P. I. Rafailidis ◽  
D. Kofteridis ◽  
S. Virtzili ◽  
F. C. Chelvatzoglou ◽  
...  

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