A case-case-control study of patients with carbapenem-resistant and third-generation cephalosporin-resistant Klebsiella pneumoniae bloodstream infections.
Antimicrob Agents Chemother. 2014 Jul 14;
Authors: Gallagher JC, Kuriakose S, Haynes K, Axelrod P
BACKGROUND: Strains of third-generation-cephalosporin-resistant K. pneumoniae (3GCRKP) and carbapenem-resistant K. pneumoniae (CRKP) are rapidly spreading. Evidence is needed to establish whether differences exist between patients at risk for 3GCKRP and CRKP bloodstream infections (BSIs), thus this study was conducted to determine if risk factors differ between these two infections.
METHODS: This was a retrospective case-case-control study. Inclusion criteria for cases were positive blood cultures for K. pneumoniae, first episode of BSI, age ≥ 18, and susceptibility results indicating resistance to either 3rd-generation cephalosporins (3GCRKP group) or carbapenems and cephalosporins (CRKP group). Controls were patients admitted ≥72 hours and were matched to cases by month/year and medical unit. Variables of interest were analyzed by univariate analysis and those of significance were analyzed by logistic regression.
RESULTS: 111 patients with 3GCR KP BSIs and 43 patients with CR KP BSIs were matched to 154 controls. Multivariate analyses of 3GCRKP case and control groups demonstrated that LOS >40 days (OR 17.7, 95% CI 3.7-84.3), antibiotics in the past 90 days (OR 4.3,95% CI 1.5-11.9), and presence of a central venous catheter (OR 4.1, 95% CI 1.3-13.4) were independent risk factors. Multivariate analyses of the CRKP case and control groups demonstrated that LOS > 40 days (OR 13.5, 95% CI 2.9-62.8) and antibiotics in the past 90 days (OR 5.9, 95% CI 1.3-26.5) were independent risk factors.
CONCLUSION: Similar factors put patients at risk for both types of K. pneumoniae BSIs.
PMID: 25022587 [PubMed - as supplied by publisher]