Spectrum of excess mortality due to carbapenem-resistant Klebsiella pneumoniae infections.
Clin Microbiol Infect. 2016 Feb 2;
Authors: Hauck C, Cober E, Richter SS, Perez F, Salata RA, Kalayjian RC, Watkins RR, Scalera NM, Doi Y, Kaye KS, Evans S, Fowler VG, Bonomo RA, van Duin D, Antibacterial Resistance Leadership Group
Patients infected or colonized with carbapenem-resistant Klebsiella pneumoniae (CRKp) are often chronically and acutely ill, which results in substantial mortality that is not related 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.
PMID: 26850824 [PubMed - as supplied by publisher]