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Erschienen in: European Journal of Clinical Microbiology & Infectious Diseases 4/2017

01.12.2016 | Original Article

Previous bloodstream infections due to other pathogens as predictors of carbapenem-resistant Klebsiella pneumoniae bacteraemia in colonized patients: results from a retrospective multicentre study

verfasst von: D. R. Giacobbe, V. Del Bono, P. Bruzzi, S. Corcione, M. Giannella, A. Marchese, L. Magnasco, A. E. Maraolo, N. Pagani, C. Saffioti, S. Ambretti, C. S. Cardellino, E. Coppo, F. G. De Rosa, P. Viale, C. Viscoli, on behalf of ISGRI-SITA (Italian Study Group on Resistant Infections of the Società Italiana Terapia Antinfettiva)

Erschienen in: European Journal of Clinical Microbiology & Infectious Diseases | Ausgabe 4/2017

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Abstract

Introduction: the purpose of this retrospective multicenter study was to assess whether the risk of developing bloodstream infections (BSI) due to carbapenem-resistant Klebsiella pneumoniae (CRKP) in colonized patients is influenced by the occurrence of BSI due to other pathogens. Methods: from January 2012 to March 2014, all patients with at least one rectal swab positive for CRKP and at least 30 days of previous hospital stay were included in the study. The primary outcome measure was CRKP BSI, defined as a time-to-event endpoint. The role of potential predictors was evaluated through univariable and multivariable Cox regression analyses, considering previous BSI as a time-dependent variable. Results: during the study period, 353 patients met the inclusion criteria. Thirty-seven developed a CRKP BSI (11%). A higher incidence of CRKP BSI was observed in presence rather than in absence of previous BSI. In the final multivariable model of risk factors for CRKP BSI, multisite colonization (hazard ratio [HR] 13.73, 95% confidence intervals [CI] 3.29–57.32, p < 0.001), ICU stay (HR 3.14, 95% CI 1.19–8.31, p = 0.021), and previous BSI (p = 0.026, with the overall effect being mainly due to Enterococcus spp. BSI vs absence of BSI, HR 6.62, 95% CI 2.11–20.79) were associated with the development of CRKP BSI, while an inverse association was observed for age (HR 0.98, 95% CI 0.95–1.00, p = 0.027). Conclusions: previous BSI due to other pathogens were associated with an increased risk of CRKP BSI that was independent of other factors in colonized patients with prolonged hospital exposure.
Literatur
1.
Zurück zum Zitat Hauck C, Cober E, Richter SS, Perez F, Salata RA, Kalayjian RC et al (2016) Spectrum of excess mortality due to carbapenem-resistant Klebsiella pneumoniae infections. Clin Microbiol Infect 22(6):513–519CrossRefPubMed Hauck C, Cober E, Richter SS, Perez F, Salata RA, Kalayjian RC et al (2016) Spectrum of excess mortality due to carbapenem-resistant Klebsiella pneumoniae infections. Clin Microbiol Infect 22(6):513–519CrossRefPubMed
2.
Zurück zum Zitat Tumbarello M, Trecarichi EM, De Rosa FG, Giannella M, Giacobbe DR, Bassetti M et al (2015) Infections caused by KPC-producing Klebsiella pneumoniae: differences in therapy and mortality in a multicentric study. J Antimicrob Chemother 70:2133–2143CrossRefPubMed Tumbarello M, Trecarichi EM, De Rosa FG, Giannella M, Giacobbe DR, Bassetti M et al (2015) Infections caused by KPC-producing Klebsiella pneumoniae: differences in therapy and mortality in a multicentric study. J Antimicrob Chemother 70:2133–2143CrossRefPubMed
3.
Zurück zum Zitat Munoz-Price LS, Poirel L, Bonomo RA, Schwaber MJ, Daikos GL, Cormican M et al (2013) Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases. Lancet Infect Dis 13:785–796CrossRefPubMedPubMedCentral Munoz-Price LS, Poirel L, Bonomo RA, Schwaber MJ, Daikos GL, Cormican M et al (2013) Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases. Lancet Infect Dis 13:785–796CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Nordmann P, Dortet L, Poirel L (2012) Carbapenem resistance in Enterobacteriaceae: here is the storm! Trends Mol Med 18:263–272CrossRefPubMed Nordmann P, Dortet L, Poirel L (2012) Carbapenem resistance in Enterobacteriaceae: here is the storm! Trends Mol Med 18:263–272CrossRefPubMed
5.
Zurück zum Zitat Alicino C, Giacobbe DR, Orsi A et al (2015) Trends in the annual incidence of carbapenem-resistant Klebsiella pneumoniae bloodstream infections: a 8-year retrospective study in a large teaching hospital in northern Italy. BMC Infect Dis 15:415CrossRefPubMedPubMedCentral Alicino C, Giacobbe DR, Orsi A et al (2015) Trends in the annual incidence of carbapenem-resistant Klebsiella pneumoniae bloodstream infections: a 8-year retrospective study in a large teaching hospital in northern Italy. BMC Infect Dis 15:415CrossRefPubMedPubMedCentral
6.
7.
Zurück zum Zitat Bogan C, Kaye KS, Chopra T, Hayakawa K, Pogue JM, Lephart PR et al (2014) Outcomes of carbapenem-resistant Enterobacteriaceae isolation: matched analysis. Am J Infect Control 42(6):612–620CrossRefPubMed Bogan C, Kaye KS, Chopra T, Hayakawa K, Pogue JM, Lephart PR et al (2014) Outcomes of carbapenem-resistant Enterobacteriaceae isolation: matched analysis. Am J Infect Control 42(6):612–620CrossRefPubMed
8.
Zurück zum Zitat Giacobbe DR, Del Bono V, Trecarichi EM, De Rosa FG, Giannella M, Bassetti M et al (2015) Risk factors for bloodstream infections due to colistin-resistant KPC-producing Klebsiella pneumoniae: results from a multicenter case–control-control study. Clin Microbiol Infect 21:1106.e1–1106.e8CrossRef Giacobbe DR, Del Bono V, Trecarichi EM, De Rosa FG, Giannella M, Bassetti M et al (2015) Risk factors for bloodstream infections due to colistin-resistant KPC-producing Klebsiella pneumoniae: results from a multicenter case–control-control study. Clin Microbiol Infect 21:1106.e1–1106.e8CrossRef
9.
Zurück zum Zitat Falcone M, Russo A, Iacovelli A et al (2016) Predictors of outcome in ICU patients with septic shock caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae. Clin Microbiol Infect 22(5):444–450CrossRefPubMed Falcone M, Russo A, Iacovelli A et al (2016) Predictors of outcome in ICU patients with septic shock caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae. Clin Microbiol Infect 22(5):444–450CrossRefPubMed
10.
Zurück zum Zitat Borer A, Saidel-Odes L, Eskira S et al (2012) Risk factors for developing clinical infection with carbapenem-resistant klebsiella pneumoniae in hospital patients initially only colonized with carbapenem-resistant k pneumoniae. Am J Infect Control 40:421–425CrossRefPubMed Borer A, Saidel-Odes L, Eskira S et al (2012) Risk factors for developing clinical infection with carbapenem-resistant klebsiella pneumoniae in hospital patients initially only colonized with carbapenem-resistant k pneumoniae. Am J Infect Control 40:421–425CrossRefPubMed
11.
Zurück zum Zitat Schechner V, Kotlovsky T, Kazma M et al (2013) Asymptomatic rectal carriage of blakpc producing carbapenem-resistant enterobacteriaceae: who is prone to become clinically infected? Clin Microbiol Infect 19:451–456CrossRefPubMed Schechner V, Kotlovsky T, Kazma M et al (2013) Asymptomatic rectal carriage of blakpc producing carbapenem-resistant enterobacteriaceae: who is prone to become clinically infected? Clin Microbiol Infect 19:451–456CrossRefPubMed
12.
Zurück zum Zitat Giannella M, Trecarichi EM, De Rosa FG, Del Bono V, Bassetti M, Lewis RE et al (2014) Risk factors for carbapenem-resistant Klebsiella pneumoniae bloodstream infection among rectal carriers: a prospective observational multicentre study. Clin Microbiol Infect 20:1357–1362CrossRefPubMed Giannella M, Trecarichi EM, De Rosa FG, Del Bono V, Bassetti M, Lewis RE et al (2014) Risk factors for carbapenem-resistant Klebsiella pneumoniae bloodstream infection among rectal carriers: a prospective observational multicentre study. Clin Microbiol Infect 20:1357–1362CrossRefPubMed
13.
Zurück zum Zitat Salsano A, Giacobbe DR, Sportelli E, Olivieri GM, Brega C, Di Biase C et al (2016) Risk factors for infections due to carbapenem-resistant Klebsiella pneumoniae after open heart surgery. Interact Cardiovasc Thorac Surg 23(5):762–768 Salsano A, Giacobbe DR, Sportelli E, Olivieri GM, Brega C, Di Biase C et al (2016) Risk factors for infections due to carbapenem-resistant Klebsiella pneumoniae after open heart surgery. Interact Cardiovasc Thorac Surg 23(5):762–768
14.
Zurück zum Zitat Giannella M, Bartoletti M, Morelli MC, Tedeschi S, Cristini F, Tumietto F et al (2015) Risk factors for infection with carbapenem-resistant Klebsiella pneumoniae after liver transplantation: the importance of pre- and post-transplant colonization. Am J Transplant 15:1708–1715CrossRefPubMed Giannella M, Bartoletti M, Morelli MC, Tedeschi S, Cristini F, Tumietto F et al (2015) Risk factors for infection with carbapenem-resistant Klebsiella pneumoniae after liver transplantation: the importance of pre- and post-transplant colonization. Am J Transplant 15:1708–1715CrossRefPubMed
15.
Zurück zum Zitat Di Carlo P, Gulotta G, Casuccio A et al (2013) KPC — 3 Klebsiella pneumoniae ST258 clone infection in postoperative abdominal surgery patients in an intensive care setting: analysis of a case series of 30 patients. BMC Anesthesiol 13:13CrossRefPubMedPubMedCentral Di Carlo P, Gulotta G, Casuccio A et al (2013) KPC — 3 Klebsiella pneumoniae ST258 clone infection in postoperative abdominal surgery patients in an intensive care setting: analysis of a case series of 30 patients. BMC Anesthesiol 13:13CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Tumbarello M, Trecarichi EM, Tumietto F, Del Bono V, De Rosa FG, Bassetti M et al (2014) Predictive models for identification of hospitalized patients harboring KPC-producing Klebsiella pneumoniae. Antimicrob Agents Chemother 58:3514–3520CrossRefPubMedPubMedCentral Tumbarello M, Trecarichi EM, Tumietto F, Del Bono V, De Rosa FG, Bassetti M et al (2014) Predictive models for identification of hospitalized patients harboring KPC-producing Klebsiella pneumoniae. Antimicrob Agents Chemother 58:3514–3520CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Daikos GL, Tsaousi S, Tzouvelekis LS, Anyfantis I, Psichogiou M, Argyropoulou A et al (2014) Carbapenemase-producing Klebsiella pneumoniae bloodstream infections: lowering mortality by antibiotic combination schemes and the role of carbapenems. Antimicrob Agents Chemother 58:2322–2328CrossRefPubMedPubMedCentral Daikos GL, Tsaousi S, Tzouvelekis LS, Anyfantis I, Psichogiou M, Argyropoulou A et al (2014) Carbapenemase-producing Klebsiella pneumoniae bloodstream infections: lowering mortality by antibiotic combination schemes and the role of carbapenems. Antimicrob Agents Chemother 58:2322–2328CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Amit S, Mishali H, Kotlovsky T, Schwaber MJ, Carmeli Y (2015) Bloodstream infections among carriers of carbapenem-resistant Klebsiella pneumoniae: etiology, incidence and predictors. Clin Microbiol Infect 21:30–34CrossRefPubMed Amit S, Mishali H, Kotlovsky T, Schwaber MJ, Carmeli Y (2015) Bloodstream infections among carriers of carbapenem-resistant Klebsiella pneumoniae: etiology, incidence and predictors. Clin Microbiol Infect 21:30–34CrossRefPubMed
19.
Zurück zum Zitat Tumbarello M, Viale P, Viscoli C et al (2012) Predictors of mortality in bloodstream infections caused by kpc-producing klebsiella pneumoniae: importance of combination therapy. Clin Infect Dis 55:943–950CrossRefPubMed Tumbarello M, Viale P, Viscoli C et al (2012) Predictors of mortality in bloodstream infections caused by kpc-producing klebsiella pneumoniae: importance of combination therapy. Clin Infect Dis 55:943–950CrossRefPubMed
20.
Zurück zum Zitat Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefPubMed Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefPubMed
21.
22.
Zurück zum Zitat Cole GT, Halawa AA, Anaissie EJ (1996) The role of the gastrointestinal tract in hematogenous candidiasis: from the laboratory to the bedside. Clin Infect Dis 22(Suppl 2):S73–S88CrossRefPubMed Cole GT, Halawa AA, Anaissie EJ (1996) The role of the gastrointestinal tract in hematogenous candidiasis: from the laboratory to the bedside. Clin Infect Dis 22(Suppl 2):S73–S88CrossRefPubMed
23.
Zurück zum Zitat Russo A, Falcone M, Fantoni M et al (2015) Risk factors and clinical outcomes of candidaemia in patients treated for Clostridium difficile infection. Clin Microbiol Infect 21:493.e1–493.e4CrossRef Russo A, Falcone M, Fantoni M et al (2015) Risk factors and clinical outcomes of candidaemia in patients treated for Clostridium difficile infection. Clin Microbiol Infect 21:493.e1–493.e4CrossRef
24.
Zurück zum Zitat Papadimitriou-Olivgeris M, Spiliopoulou A, Fligou F et al (2014) Association of KPC-producing Klebsiella pneumoniae colonization or infection with Candida isolation and selection of non-albicans species. Diagn Microbiol Infect Dis 80:227–232CrossRefPubMed Papadimitriou-Olivgeris M, Spiliopoulou A, Fligou F et al (2014) Association of KPC-producing Klebsiella pneumoniae colonization or infection with Candida isolation and selection of non-albicans species. Diagn Microbiol Infect Dis 80:227–232CrossRefPubMed
25.
Zurück zum Zitat De Rosa FG, Corcione S, Pagani N, Di Perri G (2015) From ESKAPE to ESCAPE, from KPC to CCC. Clin Infect Dis 60:1289–1290CrossRefPubMed De Rosa FG, Corcione S, Pagani N, Di Perri G (2015) From ESKAPE to ESCAPE, from KPC to CCC. Clin Infect Dis 60:1289–1290CrossRefPubMed
26.
Zurück zum Zitat Munoz-Price LS, Frencken JF, Tarima S, Bonten M (2016) Handling time-dependent variables: antibiotics and antibiotic resistance. Clin Infect Dis 62(12):1558–1563CrossRefPubMed Munoz-Price LS, Frencken JF, Tarima S, Bonten M (2016) Handling time-dependent variables: antibiotics and antibiotic resistance. Clin Infect Dis 62(12):1558–1563CrossRefPubMed
27.
Zurück zum Zitat Souvenir D, Anderson DE Jr, Palpant S et al (1998) Blood cultures positive for coagulase-negative staphylococci: antisepsis, pseudobacteremia, and therapy of patients. J Clin Microbiol 36:1923–1926PubMedPubMedCentral Souvenir D, Anderson DE Jr, Palpant S et al (1998) Blood cultures positive for coagulase-negative staphylococci: antisepsis, pseudobacteremia, and therapy of patients. J Clin Microbiol 36:1923–1926PubMedPubMedCentral
Metadaten
Titel
Previous bloodstream infections due to other pathogens as predictors of carbapenem-resistant Klebsiella pneumoniae bacteraemia in colonized patients: results from a retrospective multicentre study
verfasst von
D. R. Giacobbe
V. Del Bono
P. Bruzzi
S. Corcione
M. Giannella
A. Marchese
L. Magnasco
A. E. Maraolo
N. Pagani
C. Saffioti
S. Ambretti
C. S. Cardellino
E. Coppo
F. G. De Rosa
P. Viale
C. Viscoli
on behalf of ISGRI-SITA (Italian Study Group on Resistant Infections of the Società Italiana Terapia Antinfettiva)
Publikationsdatum
01.12.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Clinical Microbiology & Infectious Diseases / Ausgabe 4/2017
Print ISSN: 0934-9723
Elektronische ISSN: 1435-4373
DOI
https://doi.org/10.1007/s10096-016-2843-1

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