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

  • David van Duin (a1), Eric Cober (a2), Sandra S. Richter (a3), Federico Perez (a4) (a5), Robert C. Kalayjian (a6), Robert A. Salata (a5), Scott Evans (a7), Vance G. Fowler (a8), Robert A. Bonomo (a4) (a5) (a9) and Keith S. Kaye (a10)...
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

Copyright
Corresponding author
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).
Linked references
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3. D van Duin , KS Kaye , EA Neuner , RA Bonomo . Carbapenem-resistant Enterobacteriaceae: a review of treatment and outcomes. Diagn Microbiol Infect Dis 2013;75:115120.

5. A Walkty , H Adam , M Baxter , 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;58:25542563.

7. D Van Duin , E Cober , S Richter , et al. Tigecycline therapy for carbapenem-resistant Klebsiella pneumoniae (CRKP) bacteriuria leads to tigecycline resistance. Clin Microbiol Infect 2014;20:O1117O1120.

10. LA Mandell , RG Wunderink , A Anzueto , 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):S27S72.

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;171:388416.

13. JW Chow , VL Yu . Combination antibiotic therapy versus monotherapy for Gram-negative bacteraemia: a commentary. Int J Antimicrob Agents 1999;11:712.

14. ME Charlson , P Pompei , KL Ales , CR MacKenzie . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373383.

19. A Adler , O Hussein , D Ben-David , 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;70:8992.

21. N Daneman , A Gruneir , SE Bronskill , et al. Prolonged antibiotic treatment in long-term care: role of the prescriber. JAMA Intern Med 2013;173:673682.

22. N Daneman , A Gruneir , A Newman , et al. Antibiotic use in long-term care facilities. J Antimicrob Chemother 2011;66:28562863.

23. N Safdar , DG Maki . 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;136:834844.

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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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