Epidemiology, Management, and Outcome of Carbapenem-Resistant Klebsiella Pneumoniae Bloodstream Infections in Hospitals Within the Same Endemic Metropolitan Area

J Infect Public Health. Mar-Apr 2018;11(2):171-177. doi: 10.1016/j.jiph.2017.06.003. Epub 2017 Jun 28.

Abstract

In the last decade, carbapenem-resistant Klebsiella pneumoniae (CR-Kp) has become endemic in several countries, including Italy. In the present study, we assessed the differences in epidemiology, management, and mortality of CR-Kp bloodstream infection (BSI) in the three main adult acute-care hospitals of the metropolitan area of Genoa, Italy. From January 2013 to December 2014, all patients with CR-Kp BSI were identified through the computerized microbiology laboratory databases of the three hospitals. The primary endpoints of the study were incidence and characteristics of CR-Kp BSI in hospitals within the same endemic metropolitan area. Secondary endpoints were characteristics of CR-Kp BSI in hospitals with and without internal infectious diseases consultants (IDCs) and 15-day mortality. During the study period, the incidence of healthcare-associated CR-Kp BSI in the entire study population was 1.35 episodes per 10,000 patient-days, with substantial differences between the three hospitals. Patients admitted to the two hospital with internal IDCs were more likely to receive post-susceptibility test combined therapy including carbapenems (77% vs. 26%, p<0.001), adequate post-susceptibility test therapies (86% vs. 52%, p<0.001), and post-susceptibility therapies prescribed by an infectious diseases specialist (84% vs. 14%, p<0.001). Overall, the crude 15-days mortality was 26%. In the final multivariable model, only septic shock at BSI presentation was unfavorably and independently associated with 15-days mortality (odds ratio [OR] 6.7, 95% confidence intervals [CI] 2.6-17.6, p<0.001), while a protective effect was observed for post-susceptibility test combined therapies including a carbapenem (OR 0.11, 95% CI 0.03-0.43, p=0.002). Mortality of CR-Kp remains high. Differences in the incidence of CR-Kp BSI were detected between acute-care centers within the same endemic metropolitan area. Efforts should be made to improve the collaboration and coordination between centers, to prevent further diffusion of CR-Kp.

Keywords: BSI; Bloodstream infection; CRKP; Carbapenem-resistant Klebsiella pneumoniae; Epidemiology.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Bacteremia / drug therapy
  • Bacteremia / microbiology
  • Carbapenems / pharmacology*
  • Carbapenems / therapeutic use
  • Cities
  • Cross Infection / epidemiology
  • Cross Infection / microbiology
  • Disease Management
  • Drug Resistance, Bacterial*
  • Female
  • Hospitals / statistics & numerical data
  • Humans
  • Incidence
  • Italy / epidemiology
  • Klebsiella Infections / blood
  • Klebsiella Infections / epidemiology*
  • Klebsiella Infections / mortality
  • Klebsiella pneumoniae / drug effects*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome

Substances

  • Carbapenems