Risk factors for bacteriuria with carbapenem-resistant Klebsiella pneumoniae and its impact on mortality: a case–control study

  title={Risk factors for bacteriuria with carbapenem-resistant Klebsiella pneumoniae and its impact on mortality: a case–control study},
  author={Smadar Shilo and Marc V. Assous and Tamar Lachish and Puah Kopuit and Tali Bdolah‐Abram and Amos M. Yinnon and Yonit Wiener‐Well},
BackgroundThe objective of this study was to evaluate the mortality of and risk factors for bacteriuria due to carbapenem-resistant Klebsiella pneumoniae (CRKp) versus carbapenem-susceptible K. pneumoniae (CSKp) producing extended spectrum β lactamase (ESBL).MethodsThis was a retrospective case–control study in which 135 case-patients with bacteriuria due to CRKp were compared with 127 control patients with CSKp producing ESBL. In a first step, multivariate Cox regression and Kaplan–Meier… 

Risk factors for carbapenem-resistant Klebsiella pneumoniae infection relative to two types of control patients: a systematic review and meta-analysis

A systematic review and meta-analysis found that eight shared factors are likely to be ‘true’ risk factors for CRKP infection and eight factors may be associated with both K. pneumoniae infections in general andCRKP in particular.

Infections Caused by Carbapenemase-Producing Klebsiella pneumoniae: Microbiological Characteristics and Risk Factors

Multivariate conditional logistic regression analysis demonstrated that Pitt bacteremia score >4, prior stomach tube, continuous renal replacement therapy (CRRT), and previous carbapenem exposure were associated with CPKP infection, and higher albumin concentration and use of cephalosporins after diagnosis were strong prognostic factors for crude 28-day mortality.

A retrospective, comparative analysis of risk factors and outcomes in carbapenem-susceptible and carbapenem-nonsusceptible Klebsiella pneumoniae bloodstream infections: tigecycline significantly increases the mortality

Exposure to carbapenems and severe illness were independent risk factors for the development of CnSKP-BSIs, and tigecycline therapy resulted in a significant increase in mortality.

Epidemiology and Clinical Outcomes of Patients with Carbapenem-Resistant Klebsiella pneumoniae Bacteriuria

Identification of CRKP in the urine was most commonly associated with ASB and did not lead to subsequent infections or death among asymptomatic patients, and doxycycline may be an effective therapy for CRkP UTIs.

A Novel Nomogram for Predicting Risk Factors and Outcomes in Bloodstream Infections Caused by Klebsiella pneumoniae

Previous transplantations, prior ICU stay, gastric tube indwelling before BSI, more types of antibiotics use before B SI, lower Hb and cholinesterase represent significant risk factors for the development of BSI-CRKP.

Systematic review and meta-analysis of mortality of patients infected with carbapenem-resistant Klebsiella pneumoniae

It is suggested that patients infected with CRKP have higher mortality than those infected with CSKP, especially in association with BSI, ICU admission, or SOT, and that strict infection control measures and new antibiotics are required to protect againstCRKP infection.

Impact of carbapenem resistance on mortality in patients infected with Enterobacteriaceae: a systematic review and meta-analysis

The results suggested that patients with CRE infection still face a greater risk of death than patients with CSE infection do, and an urgent need to develop new antibiotics and appropriate treatments to reduce the risk ofdeath.

A Systematic Review and Meta-analyses of the Clinical Epidemiology of Carbapenem-Resistant Enterobacteriaceae

This systematic review aimed to identify risk factors for CRE acquisition among hospitalized patients, and found that the use of medical devices generated the highest pooled estimate, followed by carbapenem use.



Predictors of Carbapenem-Resistant Klebsiella pneumoniae Acquisition among Hospitalized Adults and Effect of Acquisition on Mortality

CRKP affects patients with poor functional status, an ICU stay, and antibiotic exposure and is an independent predictor of death.

Risk factors of carbapenem-resistant Klebsiella pneumoniae infections: a matched case control study.

The data suggest that prior exposure to fluoroquinolones and antipseudomonal penicillins are independent risk factors for the development of CRKp infections.

Risk Factors for and Clinical Outcomes of Bloodstream Infections Caused by Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae

For K. pneumoniae bacteremia, patients with ESBL-KP had a higher initial treatment failure rate but did not have higher mortality if antimicrobial therapy was appropriately adjusted in this study with limited statistical power.

Risk factors for the acquisition of carbapenem-resistant Klebsiella pneumoniae among hospitalized patients.

The results suggest that the nosocomial isolation of CRKP is strongly favored by the selection pressure of carbapenem.

Attributable Mortality Rate for Carbapenem-Resistant Klebsiella pneumoniae Bacteremia

It is shown that the crude and attributable mortality rates associated with carbapenem-resistant K. pneumoniae bacteremia were striking.

Outcome of carbapenem resistant Klebsiella pneumoniae bloodstream infections.

  • D. Ben-DavidR. Kordevani G. Rahav
  • Medicine, Biology
    Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
  • 2012
Patients with carbapenem-resistant K. pneumoniae had higher rates of prior antimicrobial exposure, other nosocomial infections, and use of invasive devices; and independent risk factors for infection-related mortality were Pitt bacteraemia score, Charlson score and carbAPenem resistance.

Potential Role of Active Surveillance in the Control of a Hospital-Wide Outbreak of Carbapenem-Resistant Klebsiella pneumoniae Infection

The use of active surveillance and contact precautions, as part of a multifactorial intervention, may be an effective strategy to decrease rates of nosocomial transmission of carbapenem-resistant K. pneumoniae infection.

Assessment of the Clinical Significance of Production of Extended-spectrum β-Lactamases (ESBL) by Enterobacteriaceae

Mortality of patients with ESBL(+) sepsis was higher than that of patientsWith urosepsis, who constituted the majority of patients in this study, the reason appears to be related to other factors rather than to empiric treatment with cephalosporins or the nature or resistance pattern of the organism.

Extended-spectrum β-lactamase-producing Gram-negative pathogens in community-acquired urinary tract infections: an increasing challenge for antimicrobial therapy

Fosfomycin or nitrofurantoin are recommended for the first-line empirical oral treatment of community-acquired uncomplicated UTIs and guidelines for the management of UTIs must be revised because of increasing antibiotic resistance rates of E. coli.