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Outcomes of Carbapenem-Resistant Klebsiella pneumoniae Infection and the Impact of Antimicrobial and Adjunctive Therapies

  • Gopi Patel (a1), Shirish Huprikar (a1), Stephanie H. Factor (a1), Stephen G. Jenkins (a1) (a2) and David P. Calfee (a1)...
Background.</title> <p>Carbapenem-resistant <span class='italic'>Klebsiella pneumoniae</span> is an emerging healthcare-associated pathogen.</p> </sec> <sec id='abs2'> <title>Objective.</title> <p>To describe the epidemiology of and clinical outcomes associated with carbapenem-resistant <span class='italic'>K. pneumoniae</span> infection and to identify risk factors associated with mortality among patients with this type of infection.</p> </sec> <sec id='abs3'> <title>Setting.</title> <p>Mount Sinai Hospital, a 1,171-bed tertiary care teaching hospital in New York City.</p> </sec> <sec id='abs4'> <title>Design.</title> <p>Two matched case-control studies.</p> </sec> <sec id='abs5'> <title>Methods.</title> <p>In the first matched case-control study, case patients with carbapenem-resistant <span class='italic'>K. pneumoniae</span> infection were compared with control patients with carbapenem-susceptible <span class='italic'>K. pneumoniae</span> infection. In the second case-control study, patients who survived carbapenem-resistant <span class='italic'>K. pneumoniae</span> infection were compared with those who did not survive, to identify risk factors associated with mortality among patients with carbapenem-resistant <span class='italic'>K. pneumoniae</span> infection.</p> </sec> <sec id='abs6'> <title>Results.</title> <p>There were 99 case patients and 99 control patients identified. Carbapenem-resistant <span class='italic'>K. pneumoniae</span> infection was independently associated with recent organ or stem-cell transplantation (<span class='italic'>P</span> = .008), receipt of mechanical ventilation (<span class='italic'>P</span> = .04), longer length of stay before infection (<span class='italic'>P</span> = .01), and exposure to cephalosporins (<span class='italic'>P</span> = .02) and carbapenems (<span class='italic'>P</span> < .001). Case patients were more likely than control patients to die during hospitalization (48% vs 20%; <span class='italic'>P</span> < .001) and to die from infection (38% vs 12%; <span class='italic'>P</span> < .001). Removal of the focus of infection (ie, debridement) was independently associated with patient survival (<span class='italic'>P</span> = .002). The timely administration of antibiotics with in vitro activity against carbapenem-resistant <span class='italic'>K. pneumoniae</span> was not associated with patient survival.</p> </sec> <sec id='abs7'> <title>Conclusions.
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.

Copyright
Corresponding author
Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1151, New York, NY 10029 (david.calfee@mountsinai.org)
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1.National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470485.

2. S Cosgrove , G Sakoulas , E Perencevich , M Schwaber , A Karchmer , Y Carmeli . Comparison of mortality with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003;36:5359.

3. S Cosgrove , Y Qi , K Kaye , S Harbarth , A Karchmer , Y Carmeli . The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005;26:166174.

4. J Engemann , Y Carmeli , S Cosgrove , et al. Adverse clinical and epidemiologic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003;36:592598.

5. S Reed , J Friedman , J Engemann , et al. Costs and outcomes among hemodialysis-dependent patients with methicillin-resistant or methicillin-susceptible Staphylococcus aureus bacteremia. Infect Control Hosp Epidemiol 2005;26:175183.

6. E Lautenbach , J Patel , W Bilker , P Edelstein , NO Fishman . Extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for infection and impact of resistance on outcomes. Clin Infect Dis 2001;32:11621171.

7. S Lee , S Kotapati , J Kuti , C Nightingale , DP Nicolau . Impact of extended-spectrum β-lactamase-producing Escherichia coil and Klebsiella species on clinical outcomes and hospital costs: a matched cohort study. Infect Control Hosp Epidemiol 2006;27:12261232.

9. J Chow , DM Shlaes . Imipenem resistance associated with the loss of a 40-kDa outer membrane protein in Enterobacter aerogenes. J Antimicrob Chemother 1991;28:499504.

11. F MacKenzie , K Forbes , T Dorai-John , S Amyes , IM Gould . Emergence of a carbapenem-resistant Klebsiella pneumoniae. Lancet 1997;350:783.

12. L Deshpande , R Jones , T Fritsche , HS Sader . Occurrence and characterization of carbapenemase-producing Enterobacteriaceae: report from the SENTRY Antimicrobial Surveillance Program (2000-2004). Mi-crob Drug Resist 2006;12:223230.

13. S Bratu , M Mooty , S Nichani , et al. Emergence of KPC-possessing Klebsiella pneumoniae in Brooklyn, New York: epidemiology and recommendations for detection. Antimicrob Agents Chemother 2005;49:30183020.

14. M Schwaber , S Klarfeld-Lidji , S Navon-Venezia , D Schwartz , A Leavitt , Y Carmeli . Predictors of carbapenem-resistant Klebsiella pneumoniae acquisition among hospitalized adults, and effect of acquisition on mortality. Antimicrob Agents Chemother 2008;52:10281033.

15. D Landman , S Bratu , S Kochar , et al. Evolution of antimicrobial resistance among Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae in Brooklyn, NY. J Antimicrob Chemother 2007;60:7882.

16. M Falagas , P Rafailidis , D Kofteridis , et al. Risk factors of carbapenem-resistant Klebsiella pneumoniae infections: a matched case-control study. J Antimicrob Chemother 2007;60:11241130.

21. M Ahmad , C Urban , N Mariano , et al. Clinical characteristics and molecular epidemiology associated with imipenem-resistant Klebsiella pneumoniae. Clin Infect Dis 1999;29:352355.

22. Y Kwak , S Choi , E Choo , et al. Risk factors for the acquisition of carbapenem-resistant Klebsiella pneumoniae among hospitalized patients. Microb Drug Resist 2005;11:165169.

23. N Singh , M Wagener , A Obman , T Cacciarelli , M de Vera , T Gayowski . Bacteremias in liver transplant recipients: shift toward gram-negative bacteria as predominant pathogens. Liver Transpl 2004;10:844849.

24. S Bratu , P Tolaney , U Karumudi , et al. Carbapenemase-producing Klebsiella pneumoniae in Brooklyn, NY: molecular epidemiology and in vitro activity of polymyxin B and other agents. J Antimicrob Chemother 2005;56:128132.

25. A Karabinis , E Paramythiotou , D Myonia-Petropoulou , et al. Colistin for Klebsiella pneumoniae-associated sepsis. Clin Infect Dis 2004;38:e79.

26. M Daly , D Riddle , N Ledeboer , W Dunne , DJ Ritchie . Tigecycline for the treatment of pneumonia and empyema caused by carbapenemase-producing Klebsiella pneumoniae. Pharmacotherapy 2007;27:10521057.

27. G Patel , A Arvelakis , B Sauter , G Gondolesi , D Caplivski , S Huprikar . Strongyloides hyperinfection syndrome after intestinal transplantation. Transpl Infect Dis 2007;10:137141.

28. A Harris , T Karchmer , Y Carmeli , MH Samore . Methodological principles of case-control studies that analyzed risk factors for antibiotic resistance: a systematic review. Clin Infect Dis 2001;32:10551061.

29. F Tenover , R Kalsi , P Williams , et al. Carbapenem resistance in Klebsiella pneumoniae not detected by automated susceptibility testing. Emerg Infect Dis 2006;12:12091213.

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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