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Risk factors for bloodstream infections due to colistin-resistant KPC-producing Klebsiella pneumoniae: results from a multicenter case-control-control study.
Clin Microbiol Infect. 2015 Aug 13;
Authors: Giacobbe DR, Bono VD, Trecarichi EM, De Rosa FG, Giannella M, Bassetti M, Bartoloni A, Losito AR, Corcione S, Bartoletti M, Mantengoli E, Saffioti C, Pagani N, Tedeschi S, Spanu T, Rossolini GM, Marchese A, Ambretti S, Cauda R, Viale P, Viscoli C, Tumbarello M, ISGRI-SITA (Italian Study Group on Resistant Infections of the Società Italiana Terapia Antinfettiva)
Abstract
The increasing prevalence of colistin-resistance (ColR) among KPC-producing Klebsiella pneumoniae (KPC-Kp) is a matter of concern, due to its unfavorable impact on mortality of KPC-Kp bloodstream infections (BSI) and the shortage of alternative therapeutic options. A matched case-control-control analysis was conducted. The primary study endpoint was to assess risk factors for ColR KPC-Kp BSI. Secondary endpoint was to describe mortality and clinical characteristic of these infections. To assess risk factors for ColR, 142 patients with ColR KPC-Kp BSI were compared with two controls groups: 284 controls without infections caused by KPC-Kp (control group A) and 284 controls with colistin-susceptible (ColS) KPC-Kp BSI (control group B). In the first multivariate analysis (cases vs. group A), previous colistin therapy, previous KPC-Kp colonization, ≥3 previous hospitalizations, Charlson score ≥3, and neutropenia were found to be associated with the development of ColR KPC-Kp BSI. In the second multivariate analysis (cases vs. group B), only previous colistin therapy, previous KPC-Kp colonization, and Charlson score ≥3 were associated with ColR. Overall, ColR among KPC-Kp blood isolates increased more than 3-fold during the 4.5 years study period, and 30-day mortality of ColR KPC-Kp BSI was as high as 51%. Strict rules for the use of colistin are mandatory to staunch the dissemination of ColR in KPC-Kp endemic hospitals.
PMID: 26278669 [PubMed - as supplied by publisher]