Risk factors for bloodstream infections due to colistin-resistant KPC-producing Klebsiella pneumoniae: Results from a multicenter case-control-control study

D. R. Giacobbe, V. Del Bono, E. M. Trecarichi, F. G. De Rosa, M. Giannella, M. Bassetti, A. Bartoloni, A. R. Losito, S. Corcione, M. Bartoletti, E. Mantengoli, C. Saffioti, N. Pagani, S. Tedeschi, T. Spanu, G. M. Rossolini, A. Marchese, S. Ambretti, R. Cauda, P. VialeC. Viscoli, M. Tumbarello

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
JournalClinical Microbiology and Infection
DOIs
Publication statusAccepted/In press - May 6 2015

Keywords

  • Bloodstream infection
  • Colistin resistance
  • Klebsiella
  • KPC
  • Risk factors

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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    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., ... Tumbarello, M. (Accepted/In press). Risk factors for bloodstream infections due to colistin-resistant KPC-producing Klebsiella pneumoniae: Results from a multicenter case-control-control study. Clinical Microbiology and Infection. https://doi.org/10.1016/j.cmi.2015.08.001