Risk factors and clinical impact of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae.
Risk factors and clinical impact of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae.
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DOI：
10.1086/648451
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发表时间：
2009-12
影响因子：
4.5
通讯作者：
Fishman NO
中科院分区：
文献类型：
--
作者：
Gasink LB;Edelstein PH;Lautenbach E;Synnestvedt M;Fishman NO
产碳青霉烯酶（KPC）的肺炎克雷伯菌。肺炎是一种具有严重临床和感染控制意义的新兴病原体。据我们所知，没有研究专门研究KPC生产K的风险因素。肺炎或其对死亡率的影响。确定产KPC克雷伯氏菌感染或定植的危险因素。肺炎，进行病例对照研究。例产KPC的克雷伯氏菌。pneumoniae与碳青霉烯敏感性肺炎克雷伯菌的对照受试者进行了比较。肺炎。一项队列研究评估了产生KPC的K.肺炎和住院死亡率。确定了五十六例患者和863例对照受试者。在多变量分析中，产生KPC的K.肺炎患者中，（1）重度疾病（校正比值比[AOR]，4.31; 95%置信区间[CI]，2.25-8.25），（2）既往使用氟喹诺酮类药物（AOR，3.39; 95% CI，1.50，7.66），（3）既往使用超广谱头孢菌素（AOR，2.55; 95% CI，1.18，5.52）。与其他解剖部位的标本比较，K。来自血液样本的肺炎分离株携带KPC的可能性较小（AOR，0.33; 95%CI，0.12，0.86）。产KPC的K.肺炎与院内死亡率独立相关（AOR，3.60; 95%CI，1.87-6.91）。产KPC的K.肺炎是一种与显著死亡率相关的新兴病原体。我们的研究结果强调迫切需要制定预防和感染控制战略。限制使用某些抗菌药物，特别是氟喹诺酮类和头孢菌素类，使用可能是有效的策略。
Klebsiella pneumoniae carbapenemase (KPC)–producing K. pneumoniae is an emerging pathogen with serious clinical and infection control implications. To our knowledge, no study has specifically examined risk factors for KPC-producing K. pneumoniae or its impact on mortality. To identify risk factors for infection or colonization with KPC-producing K. pneumoniae, a case-control study was performed. Case patients with KPC-producing K. pneumoniae were compared with control subjects with carbapenem-susceptible K. pneumoniae. A cohort study evaluated the association between KPC-producing K. pneumoniae and in-hospital mortality. Fifty-six case patients and 863 control subjects were identified. In multivariable analysis, independent risk factors for KPC-producing K. pneumoniae were (1) severe illness (adjusted odds ratio [AOR], 4.31; 95% confidence interval [CI], 2.25–8.25), (2) prior fluoroquinolone use (AOR, 3.39; 95% CI, 1.50, 7.66), and (3) prior extended-spectrum cephalosporin use (AOR, 2.55; 95% CI, 1.18, 5.52). Compared with samples from other anatomic locations, K. pneumoniae isolates from blood samples were less likely to harbor KPC (AOR, 0.33; 95% CI, 0.12, 0.86). KPC-producing K. pneumoniae was independently associated with in-hospital mortality (AOR, 3.60; 95% CI, 1.87–6.91). KPC-producing K. pneumoniae is an emerging pathogen associated with significant mortality. Our findings highlight the urgent need to develop strategies for prevention and infection control. Limiting use of certain antimicrobials, specifically fluoroquinolones and cephalosporins, use may be effective strategies.
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