Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-28T00:32:00.989Z Has data issue: false hasContentIssue false
  • English
  • Français

Attributable Mortality Rate for Carbapenem-Resistant Klebsiella pneumoniae Bacteremia

Published online by Cambridge University Press:  02 January 2015

Abraham Borer ,
Lisa Saidel-Odes ,
Klaris Riesenberg ,
Seada Eskira ,
Nejama Peled ,
Ronit Nativ ,
Francise Schlaeffer  and
Michael Sherf
Abraham Borer*
Affiliation:
Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Lisa Saidel-Odes
Affiliation:
Infectious Diseases Institute, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Klaris Riesenberg
Affiliation:
Infectious Diseases Institute, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Seada Eskira
Affiliation:
Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Nejama Peled
Affiliation:
Clinical Microbiology Laboratory, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Ronit Nativ
Affiliation:
Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Francise Schlaeffer
Affiliation:
Infectious Diseases Institute, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Michael Sherf
Affiliation:
Hospital Administration, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
*
Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, PO Box 151, Beer-Sheva 84101, Israel ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To determine the attributable (direct) mortality and morbidity caused by carbapenem-resistant Klebsiella pneumoniae bacteremia.

Design.

A matched retrospective, historical cohort design, using a stepwise procedure to stringendy match the best control subjects to the best case subjects.

Setting.

A 1,000-bed tertiary-care university teaching hospital.

Patients.

Case subjects were defined as adult patients with carbapenem-resistant K. pneumoniae bacteremia during the period from October 2005 through October 2008. Control subjects were defined as patients who were very similar to case subjects except that they did not have bacteremia.

Methods.

Matching potential control subjects to case subjects was performed at a 1:1 ratio using a computerized record system. The criteria used included same hospitalization period, similar Charlson comorbidity index, same underlying disease, same age within 10 years, and same sex. Demographic and clinical characteristics were collected from medical records.

Results.

During the study period, 319 patients developed an infection due to carbapenem-resistant K. pneumoniae. Of these 319 patients, 39 (12.2%) developed a bloodstream infection, for an overall rate of 0.59 episodes of carbapenem-resistant K. pneumoniae bacteremia per 10,000 patient-days. We excluded 7 patients from our study, leaving a total of 32 case subjects in our cohort. Case subjects were significandy more likely than control subjects (n = 32) to require care in an intensive care unit (12 case subjects [37.5%] vs 3 control subjects [9.4%]), ventilator support (17 case subjects [53.1%] vs 8 control subjects [25%]), and use of a central venous catheter (19 case subjects [59.4%] vs 9 control subjects [28.1%]). For case subjects, the crude mortality rate was 71.9% (ie, 23 of the 32 case subjects died); for control subjects, the crude mortality rate was 21.9% (ie, 7 of the 32 control subjects died) (P < .001. For case subjects, the attributable mortality was 50% (95% confidence interval [CI], 15.3%-98.6%). A mortality risk ratio of 3.3 (95% CI, 2.9-28.5) was found for case subjects with carbapenem-resistant K. pneumoniae bacteremia.

Conclusions.

Patients with carbapenem-resistant K. pneumoniae require more intensive and invasive care. We have shown that the crude and attributable mortality rates associated with carbapenem-resistant K. pneumoniae bacteremia were striking.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 10 , October 2009 , pp. 972 - 976
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Borer, A, Eskira, S, Nativ, R, et al.Carbapenem-resistant Klebsiella pneumoniae outbreak in southern Israel: from crisis to ongoing control. In: Program and abstracts of the 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy/Infectious Diseases Society of America 46th Annual Meeting (Washington, DC). Washington, DC: American Society for Microbiology; and Alexandria, VA: Infectious Diseases Society of America, 2008.Google Scholar
2.Schwaber, M, Klarfeld-Lidji, S, Navon-Venezia, S, Schwartz, D, Leavitt, A, Carmeli, Y. Predictors of carbapenem-resistant Klebsiella pneumoniae acquisition among hospitalized adults and effect of acquisition on mortality. Antimicrob Agents Chemother 2008;52:1028–1033.CrossRefGoogle ScholarPubMed
3.Samra, Z, Ofir, O, Lishtzinsky, Y, Madar-Shapiro, L, Bishara, J. Outbreak of carbapenem-resistant Klebsiella pneumoniae producing KPC-3 in a tertiary medical centre in Israel. Int J Antimicrob Agents 2007;30:525–529.Google Scholar
4.Maltezou, HC. Metallo-β-lactamases in gram-negative bacteria: introducing the era of pan-resistance? Int J Antimicrob Agents 2008;33:405.el–405.e7.Google ScholarPubMed
5.Davey, PG, Marwick, C. Appropriate vs. inappropriate antimicrobial therapy. Clin Microbiol Infect 2008;14(Suppl 3):15–21.CrossRefGoogle ScholarPubMed
6.Patel, G, Huprikar, S, Factor, SH, Jenkins, SG, Calfee, P. Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol 2008;29:1099–1106.CrossRefGoogle ScholarPubMed
7.Falagas, ME, Rafailidis, PI, Kofteridis, D, et al.Risk factors of carbapenem-resistant Klebsiella pneumoniae infections: a matched case-control study. J Antimicrob Chemother 2007;60:1124–1130.CrossRefGoogle ScholarPubMed
8.Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill Patients. Excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:1598–1601.Google Scholar
9.Edmond, MB, Ober, JF, Dawson, JD, Weinbaum, DL, Wenzel, RP. Vanco-mycin-resistant enterococcal bacteremia: natural history and attributable mortality. Clin Infect Dis 1996;23:1234–1239.CrossRefGoogle ScholarPubMed
10.Dellinger, RP, Levy, MM, Carlet, JM, et al.Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008;36:296–327.Google Scholar
11.Bauer, AW, Kirby, WMM, Sherris, JC, Turk, M. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol 1966;45:493–496.CrossRefGoogle ScholarPubMed
12.Anderson, KF, Lonsway, DR, Rasheed, JK, et al.Evaluation of methods to identify the Klebsiella pneumoniae carbapenase in enterobactereaceae. J Clin Microbiol 2007;45:2723–2725.CrossRefGoogle Scholar
13.CLSI. Performance standards for antimicrobial susceptibility testing: 16th informational supplement. Approved standard; CLSI document. Wayne, PA: CLSI, 2006; M100–S16.Google Scholar
14.Rangel-Frausto, MS, Pittet, D, Costigan, M, Hwang, T, Davis, CS, Wenzel, RP. The natural history of the systemic inflammatory response syndrome (SIRS): a prospective study. JAMA 1995;273:117–123.Google Scholar
15.Gudlaugsson, O, Gillespie, S, Lee, K, et al.Attributable mortality of nosocomial candidemia, revisited. Clin Infect Dis 2003;37:1172–1177.Google Scholar
16.Salgado, CD, Farr, BM. Outcomes associated with vancomycin-resis-tant enterococci: a meta-analysis. Infect Control Hosp Epidemiol 2003;24:690–698.CrossRefGoogle ScholarPubMed
17.Senol, E, Desjardin, J, Stark, PC, Barefoot, L, Snydman, DR. Attributable mortality of Stenotrophomonas maltophilia bacteremia. Clin Infect Dis 2002;34:1653–1656.Google Scholar
18.Redondo, CM, Arbo, MDJ, Grindlinger, J, Snydman, DR. Attributable mortality of bacteremia associated with the Bacteroides fragilis group. Clin Infect Dis 1995;20:1492–1496.Google Scholar
19.Martin, MA, Pfaller, MA, Wenzel, RP. Coagulase-negative staphylococcal bacteremia, mortality and hospital stay. Ann Intern Med 1989;110:9–16.CrossRefGoogle ScholarPubMed
20.Cobo, J, Morosini, MI, Pintado, V, et al.Use of tigecycline for the treatment of prolonged bacteremia due to a multiresistant VIM-1 and SHV-12 B-lactamase-producing Klebsiella pneumoniae epidemic clone. Diagn Microbiol Infect Dis 2008;60:319–322.CrossRefGoogle Scholar
21.Kasiakou, SK, Michalopoulos, A, Soteriades, ES, Samonis, G, Sermaides, GJ, Falagas, ME. Combination therapy with intravenous Colistin for management of infections due to multidrug-resistant gram-negative bacteria in patients without cystic fibrosis. Antimicrob Agents Chemother 2005;49:3136–3146.CrossRefGoogle ScholarPubMed