Risk factors for bloodstream infections due to colistin-resistant KPC-producing Klebsiella pneumoniae: Results from a multicenter case-control-control study
- Others:
- Giacobbe, D. R.
- Del Bono, V.
- Trecarichi, E. M.
- De Rosa, F. G.
- Giannella, M.
- Bassetti, M.
- Bartoloni, A.
- Losito, A. R.
- Corcione, S.
- Bartoletti, M.
- Mantengoli, E.
- Saffioti, C.
- Pagani, N.
- Tedeschi, S.
- Spanu, T.
- Rossolini, G. M.
- Marchese, A.
- Ambretti, S.
- Cauda, R.
- Viale, P.
- Viscoli, C.
- Tumbarello, M.
Description
The increasing prevalence of colistin resistance (ColR) Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (Kp) is a matter of concern because of its unfavourable 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 end point was to assess risk factors for ColR KPC-Kp BSI. The secondary end point was to describe mortality and clinical characteristics of these infections. To assess risk factors for ColR, 142 patients with ColR KPC-Kp BSI were compared to 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 threefold during the 4.5-year 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.
Additional details
- URL
- http://hdl.handle.net/11567/994895
- URN
- urn:oai:iris.unige.it:11567/994895
- Origin repository
- UNIGE