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Hospital Readmissions in Patients With Carbapenem-Resistant Klebsiella pneumoniae

  • Julia A. Messina (a1) (a2), Eric Cober (a3), Sandra S. Richter (a4), Federico Perez (a5) (a6), Robert A. Salata (a6), Robert C. Kalayjian (a7), Richard R. Watkins (a8) (a9), Nikole M. Scalera (a10), Yohei Doi (a11), Keith S. Kaye (a12), Scott Evans (a13), Robert A. Bonomo (a5) (a6) (a14) (a15), Vance G. Fowler (a1) (a2) and David van Duin (a16)...
Abstract
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.

Infect. Control Hosp. Epidemiol. 2016;37(3):281–288

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Copyright
Corresponding author
Address correspondence to David van Duin, MD, PhD, Division of Infectious Diseases, CB 7030, University of North Carolina, 130 Mason Farm Rd, Chapel Hill, NC 27599 (david_vanduin@med.unc.edu).
Footnotes
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Presented in part: IDWeek 2014; Philadelphia, Pennsylvania; October 11, 2014 (abstract 1804). The contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

Footnotes
References
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