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Residence in Skilled Nursing Facilities Is Associated with Tigecycline Nonsusceptibility in Carbapenem-Resistant Klebsiella pneumoniae

Published online by Cambridge University Press:  20 May 2015

David van Duin ,
Eric Cober ,
Sandra S. Richter ,
Federico Perez ,
Robert C. Kalayjian ,
Robert A. Salata ,
Scott Evans ,
Vance G. Fowler Jr. ,
Robert A. Bonomo  and
Keith S. Kaye
David van Duin*
Affiliation:
Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
Eric Cober
Affiliation:
Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
Sandra S. Richter
Affiliation:
Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
Federico Perez
Affiliation:
Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
Robert C. Kalayjian
Affiliation:
Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio
Robert A. Salata
Affiliation:
Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
Scott Evans
Affiliation:
Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
Vance G. Fowler Jr.
Affiliation:
Division of Infectious Diseases, Duke University, Durham, North Carolina
Robert A. Bonomo
Affiliation:
Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio
Keith S. Kaye
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
*
Address correspondence to David van Duin, MD, PhD, Division of Infectious Diseases, CB 7030, University of North Carolina, 130 Mason Farm Road, Chapel Hill, North Carolina 27599 (david_vanduin@med.unc.edu).
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Abstract

OBJECTIVE

To determine the rates of and risk factors for tigecycline nonsusceptibility among carbapenem-resistant Klebsiella pneumoniae (CRKPs) isolated from hospitalized patients

DESIGN

Multicenter prospective observational study

SETTING

Acute care hospitals participating in the Consortium on Resistance against Carbapenems in Klebsiella pneumoniae (CRaCKle)

PATIENTS

A cohort of 287 patients who had CRKPs isolated from clinical cultures during hospitalization

METHODS

For the period from December 24, 2011 to October 1, 2013, the first hospitalization of each patient with a CRKP during which tigecycline susceptibility for the CRKP isolate was determined was included. Clinical data were entered into a centralized database, including data regarding pre-hospital origin. Breakpoints established by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) were used to interpret tigecycline susceptibility testing.

RESULTS

Of 287 patients included in the final cohort, 155 (54%) had tigecycline-susceptible CRKPs. Of all index isolates, 81 (28%) were tigecycline-intermediate and 51 (18%) were tigecycline resistant. In multivariate modeling, independent risk factors for tigecycline nonsusceptibility were (1) admission from a skilled nursing facility (OR, 2.51; 95% CI, 1.51–4.21; P=.0004), (2) positive culture within 2 days of admission (OR, 1.82; 95% CI, 1.06–3.15; P=.03), and (3) receipt of tigecycline within 14 days (OR, 4.38, 95% CI, 1.37–17.01, P=.02).

CONCLUSIONS

In hospitalized patients with CRKPs, tigecycline nonsusceptibility was more frequently observed in those admitted from skilled nursing facilities and occurred earlier during hospitalization. Skilled nursing facilities are an important target for interventions to decrease antibacterial resistance to antibiotics of last resort for treatment of CRKPs.

Infect Control Hosp Epidemiol 2015;36(8):942–948

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 8 , August 2015 , pp. 942 - 948
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

1. Perez, F, van Duin, D. Carbapenem-resistant Enterobacteriaceae: a menace to our most vulnerable patients. Cleve Clin J Med 2013;80:225–233.CrossRefGoogle ScholarPubMed
2. Munoz-Price, LS, Poirel, L, Bonomo, RA, et al. Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases. Lancet Infect Dis 2013;13:785–796.Google Scholar
3. van Duin, D, Kaye, KS, Neuner, EA, Bonomo, RA. Carbapenem-resistant Enterobacteriaceae: a review of treatment and outcomes. Diagn Microbiol Infect Dis 2013;75:115–120.CrossRefGoogle ScholarPubMed
4. Flamm, RK, Farrell, DJ, Sader, HS, Jones, RN. Ceftazidime/avibactam activity tested against Gram-negative bacteria isolated from bloodstream, pneumonia, intra-abdominal and urinary tract infections in US medical centres (2012). J Antimicrob Chemother 2014;69:1589–1598.Google Scholar
5. Walkty, A, Adam, H, Baxter, M, et al. In vitro activity of plazomicin against 5,015 Gram-negative and Gram-positive clinical isolates obtained from patients in Canadian hospitals as part of the CANWARD Study, 2011–2012. Antimicrob Agents Chemother 2014;58:2554–2563.Google Scholar
6. Mathers, AJ, Cox, HL, Kitchel, B, et al. Molecular dissection of an outbreak of carbapenem-resistant enterobacteriaceae reveals Intergenus KPC carbapenemase transmission through a promiscuous plasmid. MBio 2011;2:e00204–e00211.CrossRefGoogle ScholarPubMed
7. Van Duin, D, Cober, E, Richter, S, et al. Tigecycline therapy for carbapenem-resistant Klebsiella pneumoniae (CRKP) bacteriuria leads to tigecycline resistance. Clin Microbiol Infect 2014;20:O1117–O1120.CrossRefGoogle ScholarPubMed
8. van Duin, D, Perez, F, Rudin, SD, et al. Surveillance of carbapenem-resistant Klebsiella pneumoniae: tracking molecular epidemiology and outcomes through a regional network. Antimicrob Agents Chemother 2014;58:4035–4041.Google Scholar
9. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Fourth Informational Supplement CLSI document M100-S24. Wayne, PA: Clinical and Laboratory Standards Institute, 2014:34.Google Scholar
10. Mandell, LA, Wunderink, RG, Anzueto, A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44(Suppl 2):S27–S72.CrossRefGoogle Scholar
11. American Thoracic Society. and Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388–416.Google Scholar
12. CDC/NHSN surveillance definitions for specific types of infections. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn. Published 2014. Accessed May 2014.Google Scholar
13. Chow, JW, Yu, VL. Combination antibiotic therapy versus monotherapy for Gram-negative bacteraemia: a commentary. Int J Antimicrob Agents 1999;11:7–12.Google Scholar
14. Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.CrossRefGoogle ScholarPubMed
15. Nigo, M, Cevallos, CS, Woods, K, et al. Nested case-control study of the emergence of tigecycline resistance in multidrug-resistant Klebsiella pneumoniae . Antimicrob Agents Chemother 2013;57:5743–5746.Google Scholar
16. Prabaker, K, Lin, MY, McNally, M, et al. Transfer from high-acuity long-term care facilities is associated with carriage of Klebsiella pneumoniae carbapenemase-producing enterobacteriaceae: a multihospital study. Infect Control Hosp Epidemiol 2012;33:1193–1199.Google Scholar
17. Marchaim, D, Chopra, T, Bogan, C, et al. The burden of multidrug-resistant organisms on tertiary hospitals posed by patients with recent stays in long-term acute care facilities. Am J Infect Control 2012;40:760–765.Google Scholar
18. Ben-David, D, Maor, Y, Keller, N, et al. Potential role of active surveillance in the control of a hospital-wide outbreak of carbapenem-resistant Klebsiella pneumoniae infection. Infect Control Hosp Epidemiol 2010;31:620–626.Google Scholar
19. Adler, A, Hussein, O, Ben-David, D, et al. Persistence of Klebsiella pneumoniae ST258 as the predominant clone of carbapenemase-producing Enterobacteriaceae in post-acute-care hospitals in Israel, 2008–13. J Antimicrob Chemother 2015;70:89–92.Google Scholar
20. Nursing homes and assisted living (long-term care facilities [LTCFs]). Centers for Disease Control and Prevention website. http://www.cdc.gov/longtermcare/. Published 2014. Accessed November 13, 2014.Google Scholar
21. Daneman, N, Gruneir, A, Bronskill, SE, et al. Prolonged antibiotic treatment in long-term care: role of the prescriber. JAMA Intern Med 2013;173:673–682.Google Scholar
22. Daneman, N, Gruneir, A, Newman, A, et al. Antibiotic use in long-term care facilities. J Antimicrob Chemother 2011;66:2856–2863.Google Scholar
23. Safdar, N, Maki, DG. The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus, Enterococcus, Gram-negative bacilli, Clostridium difficile, and Candida. Ann Intern Med 2002;136:834–844.Google Scholar
24. Tumbarello, M, Viale, P, Viscoli, C, et al. Predictors of mortality in bloodstream infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae: importance of combination therapy. Clin Infect Dis 2012;55:943–950.Google Scholar
25. Winkler, ML, Papp-Wallace, KM, Hujer, AM, et al. Unexpected challenges in treating multidrug-resistant Gram-negative bacteria: resistance to ceftazidime-avibactam in archived isolates of Pseudomonas aeruginosa . Antimicrob Agents Chemother 2015;59:1020–1029.Google Scholar
26. McKinnell, JA, Kunz, DF, Chamot, E, et al. Association between vancomycin-resistant Enterococci bacteremia and ceftriaxone usage. Infect Control Hosp Epidemiol 2012;33:718–724.Google Scholar