Impact of carbapenem resistance on the outcome of patients' hospital-acquired bacteraemia caused by Klebsiella pneumoniae
Impact of carbapenem resistance on the outcome of patients' hospital-acquired bacteraemia caused by Klebsiella pneumoniae
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DOI：
10.1016/j.jhin.2012.10.012
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发表时间：
2013-04-01
影响因子：
6.9
通讯作者：
Kassis, I.
中科院分区：
文献类型：
--
作者：
Hussein, K.;Raz-Pasteur, A.;Kassis, I.
背景：耐碳青霉烯类肠杆菌科，特别是克雷伯菌属，已成为近年来世界范围内的主要健康问题。自2006年以来，耐碳青霉烯类肺炎克雷伯菌（CRKP）感染的发病率在以色列大幅增加。由这些菌株引起的血流感染（BSI）与高治疗失败率和死亡率相关。目的：本研究旨在确定健康护理相关（HCR）K患者中碳青霉烯类耐药的危险因素。与碳青霉烯敏感的肺炎克雷伯菌相比，HCR-CRKP菌血症与死亡率相关的预测因子。方法：采用回顾性病例对照研究方法，对2004年1月至2005年12月收治的肺炎克雷伯氏菌（CSKP）患者进行回顾性研究。2006 - 2008年期间发现肺炎菌血症。耐药模式，潜在的发病率，耐药的危险因素和死亡率进行了比较CRKP和CSKP菌血症的患者。CRKP菌血症患者中，重度慢性合并症和既往抗生素使用更常见。在多变量分析中，既往使用大环内酯类和抗生素暴露>= 14天仍然是与CRKP菌血症相关的唯一独立因素。CRKP患者的死亡率明显高于CSKP患者。在多变量分析中：卧床不起、慢性肝病、Charlson合并症指数>= 5、机械通气和血液透析仍是K患者死亡率的独立相关因素。肺炎菌血症。碳青霉烯耐药不是死亡率的危险因素。结论：既往抗生素暴露是CRKP-BSI的危险因素。K.肺炎菌血症与严重的合并症有关，但与碳青霉烯耐药无关。(C)2012年，卫生保健感染协会。由爱思唯尔有限公司出版。保留所有权利。
Background: Carbapenem-resistant Enterobacteriaceae, especially Klebsiella spp., have become a major health problem recently worldwide. Since 2006 the incidence of carbapenem-resistant Klebsiella pneumoniae (CRKP) infections has increased substantially in Israel. Bloodstream infections (BSIs) caused by these strains have been associated with high rates of treatment failure and mortality.Aim: This study was designed to identify risk factors for carbapenem resistance among patients with healthcare-related (HCR) K. pneumoniae bacteraemia and predictors of mortality associated with HCR-CRKP bacteraemia compared with carbapenem-susceptible K. pneumoniae (CSKP).Methods: In this retrospective case-control study, all cases of K. pneumoniae bacteraemia during 2006-2008 were identified. Resistance patterns, underlying morbidities, risk factors for drug resistance and mortality rates were compared for patients with CRKP and CSKP bacteraemia.Findings: Two hundred and fourteen patients with CSKP bacteraemia were compared with 103 patients with CRKP bacteraemia. Severe, chronic comorbidities and prior antibiotic use were more frequent among patients with CRKP bacteraemia. On multivariate analysis prior use of macrolides and antibiotic exposure for >= 14 days remained the only independent factors associated with CRKP bacteraemia. Mortality rates of CRKP patients were significantly higher than those of CSKP patients. On multivariate analyses: bedridden status, chronic liver disease, Charlson comorbidity index >= 5, mechanical ventilation, and haemodialysis remained independently associated with mortality among patients with K. pneumoniae bacteraemia. Carbapenem resistance was not a risk factor for mortality.Conclusions: Previous antibiotic exposure is a risk factor for CRKP-BSI. Mortality among patients with K. pneumoniae bacteraemia is associated with serious comorbidities, but not with carbapenem resistance. (C) 2012 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.