Impact of carbapenem resistance on epidemiology and outcomes of nonbacteremic Klebsiella pneumoniae infections

Ny, Pamela; Nieberg, Paul; Wong-Beringer, Annie

doi:10.1016/j.ajic.2015.06.008

Cited by 19 publications

(15 citation statements)

References 28 publications

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“…The sample sizes in studies ranged from 51 to 1,101. These included studies were published from 2007 to 2016 in different countries including the United States, 21,23,27,31 China, 14,24 Brazil, 29,33 Italy, 25,30 Israel, 22 Colombia, 13 Turkey, 28 and Greece. 16,26,32 Of the 16 studies, 6 studies were retrospective cohort study designs, 26–29,31,32 1 study was a prospective cohort study design, 30 and the other 9 studies were case–control designs.…”

Section: Resultsmentioning

confidence: 99%

“…These included studies were published from 2007 to 2016 in different countries including the United States, 21,23,27,31 China, 14,24 Brazil, 29,33 Italy, 25,30 Israel, 22 Colombia, 13 Turkey, 28 and Greece. 16,26,32 Of the 16 studies, 6 studies were retrospective cohort study designs, 26–29,31,32 1 study was a prospective cohort study design, 30 and the other 9 studies were case–control designs. 13,14,16,21–25,33 Among those studies, the results of four cohort studies 26,27,31,32 and one case–control study 23 did not adjust for any potential confounders, whereas the remaining studies adjusted for several conventional risk factors.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Risk Factors for Carbapenem-ResistantKlebsiella pneumoniaeInfection: A Meta-Analysis

Xuan

Luo

et al. 2018

Microbial Drug Resistance

117

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Risk Factors for Carbapenem-ResistantKlebsiella pneumoniaeInfection: A Meta-Analysis

Xuan

Luo

et al. 2018

Microbial Drug Resistance

117

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“…Similarly, a study done in Shanghai, China showed that the 28-day mortality and in-hospital mortality rates of CRKp BSI patients were significantly higher than those of patients with carbapenem-susceptible K. pneumoniae (CSKp) BSIs (33.3% vs. 16%, p = 0.04; 42.4% vs. 24.6%, p = 0.005, respectively) [ 9 ]. Although CRKp is reportedly associated with prolonged hospitalization and mortality [ 8 , 10 – 12 ] because such patients typically receive inappropriate empiric therapy, other studies found no such relationship [ 13 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical and molecular characteristics, risk factors and outcomes of Carbapenem-resistant Klebsiella pneumoniae bloodstream infections in the intensive care unit

Zheng

Wang

Xu³

et al. 2017

Antimicrob Resist Infect Control

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BackgroundTo analyze the clinical characteristics and outcomes of carbapenem-resistant Klebsiella pneumoniae (CRKp) and carbapenem-susceptible K. pneumoniae (CSKp) bloodstream infections (BSIs), and to study the risk factors for development of CRKp BSI and K. pneumoniae BSI-related mortality.MethodsA retrospective case control study of patients with K. pneumoniae BSI was conducted in the intensive care unit of the First Affiliated Hospital, Medical of College, Zhejiang University from January 2013 to December 2014. Carbapenem resistance was defined in accordance with the Clinical and Laboratory Standards Institute 2016 guidelines. Risk factors for the development of CRKp BSI and risk factors for mortality due to K. pneumoniae BSI were assessed. Virulence genes were detected by polymerase chain reaction assay.ResultsIn total, 48 patients were enrolled in the study, including 31 (65%) patients with CRKp BSI and 17 (35%) patients with CSKp BSI. CSKp infection was associated with more severe clinical symptoms, particularly a higher serum creatinine level (165.06 ± 127.01 in the CSKp group vs. 93.77 ± 84.35 μmol/L in the CRKp group, p = 0.039), but there was no significant difference in prognosis between the CSKp and CRKp groups. On multivariate analysis, indwelling central venous catheter (p = 0.045) was the only factor independently associated with CRKp bacteremia. However, the mortality of K. pneumoniae BSI patients was not correlated with carbapenem resistance. In addition, the isolates had diverse clonality and different origins. The frequency of detection of the allS and magA virulence genes was higher in the CSKp group than in the CRKp group (alls p = 0.04; magA p = 0.047).ConclusionsPatients in the CSKp group experienced more severe clinical symptoms, although mortality did not differ significantly between the CRKp and CSKp groups. An indwelling central venous catheter was the only factor independently associated with CRKp BSI. The mortality of patients with K. pneumoniae BSI was not associated with carbapenem resistance. The frequency of virulence genes was higher in the CSKp group than in the CRKp group.

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“…For non-bacteremic CRKp infections, fewer studies specifically report mortality rates. CRKp pneumonia was associated with 24% all-cause hospital mortality in a recent US-based report and 40% all-cause 14-day mortality in a larger Italian study [11, 12]. Available data suggest that CRKp urinary tract infections are associated with only limited mortality [2, 11, 13].…”

Section: Introductionmentioning

confidence: 99%

Spectrum of excess mortality due to carbapenem-resistant Klebsiella pneumoniae infections

Hauck

Cober

Richter

et al. 2016

Clinical Microbiology and Infection

103

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Patients infected or colonized with carbapenem-resistant Klebsiella pneumoniae (CRKp) are often chronically and acutely ill, which results in substantial mortality unrelated to infection. Therefore, estimating excess mortality due to CRKp infections is challenging. The Consortium on Resistance against Carbapenems in K. pneumoniae (CRACKLE) is a prospective multicenter study. Here, patients in CRACKLE were evaluated at the time of their first CRKp bloodstream infection (BSI), pneumonia, or urinary tract infection (UTI). A control cohort of patients with CRKp urinary colonization without CRKp infection was constructed. Excess hospital mortality was defined as mortality in cases after subtracting mortality in controls. In addition, the adjusted hazard ratios (aHR) for time-to-hospital-mortality censored at 30 days associated with infection as compared to colonization were calculated in Cox proportional hazard models. In the study period, 260 patients with CRKp infections were included in the BSI (90), pneumonia (49), and UTI (121) groups, who were compared to 223 controls. All-cause hospital mortality in controls was 12%. Excess hospital mortality was 27% and 27% in patients with BSI and pneumonia, respectively. Excess hospital mortality was not observed in patients with UTI. In multivariable analyses, BSI and pneumonia as compared to controls was associated with an aHR of 2.59 (95% CI 1.52–4.50, p<0.001) and 3.44 (95% CI 1.80–6.48, p<0.001), respectively. In conclusion, in patients with CRKp infection, pneumonia is associated with the highest excess hospital mortality. Patients with BSI have slightly lower excess hospital mortality rates, whereas excess hospital mortality was not observed in hospitalized patients with UTI.

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Impact of carbapenem resistance on epidemiology and outcomes of nonbacteremic Klebsiella pneumoniae infections

Cited by 19 publications

References 28 publications

Risk Factors for Carbapenem-ResistantKlebsiella pneumoniaeInfection: A Meta-Analysis

Risk Factors for Carbapenem-ResistantKlebsiella pneumoniaeInfection: A Meta-Analysis

Clinical and molecular characteristics, risk factors and outcomes of Carbapenem-resistant Klebsiella pneumoniae bloodstream infections in the intensive care unit

Spectrum of excess mortality due to carbapenem-resistant Klebsiella pneumoniae infections

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