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Outcomes of Carbapenem-Resistant Klebsiella pneumoniae Infection and the Impact of Antimicrobial and Adjunctive Therapies

Part of: BARRY FARR AWARD RECIPIENTS

Published online by Cambridge University Press:  02 January 2015

Gopi Patel ,
Shirish Huprikar ,
Stephanie H. Factor ,
Stephen G. Jenkins  and
David P. Calfee
Gopi Patel
Affiliation:
Department of Medicine, Mount Sinai School of Medicine, New York, New York
Shirish Huprikar
Affiliation:
Department of Medicine, Mount Sinai School of Medicine, New York, New York
Stephanie H. Factor
Affiliation:
Department of Medicine, Mount Sinai School of Medicine, New York, New York
Stephen G. Jenkins
Affiliation:
Department of Medicine, Mount Sinai School of Medicine, New York, New York Department of Pathology, Mount Sinai School of Medicine, New York, New York
David P. Calfee*
Affiliation:
Department of Medicine, Mount Sinai School of Medicine, New York, New York
*
Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1151, New York, NY 10029 (david.calfee@mountsinai.org)
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Abstract

Background.

Carbapenem-resistant Klebsiella pneumoniae is an emerging healthcare-associated pathogen.

Objective.

To describe the epidemiology of and clinical outcomes associated with carbapenem-resistant K. pneumoniae infection and to identify risk factors associated with mortality among patients with this type of infection.

Setting.

Mount Sinai Hospital, a 1,171-bed tertiary care teaching hospital in New York City.

Design.

Two matched case-control studies.

Methods.

In the first matched case-control study, case patients with carbapenem-resistant K. pneumoniae infection were compared with control patients with carbapenem-susceptible K. pneumoniae infection. In the second case-control study, patients who survived carbapenem-resistant K. pneumoniae infection were compared with those who did not survive, to identify risk factors associated with mortality among patients with carbapenem-resistant K. pneumoniae infection.

Results.

There were 99 case patients and 99 control patients identified. Carbapenem-resistant K. pneumoniae infection was independently associated with recent organ or stem-cell transplantation (P = .008), receipt of mechanical ventilation (P = .04), longer length of stay before infection (P = .01), and exposure to cephalosporins (P = .02) and carbapenems (P < .001). Case patients were more likely than control patients to die during hospitalization (48% vs 20%; P < .001) and to die from infection (38% vs 12%; P < .001). Removal of the focus of infection (ie, debridement) was independently associated with patient survival (P = .002). The timely administration of antibiotics with in vitro activity against carbapenem-resistant K. pneumoniae was not associated with patient survival.

Conclusions.

Carbapenem-resistant K. pneumoniae infection is associated with numerous healthcare-related risk factors and with high mortality. The mortality rate associated with carbapenem-resistant K. pneumoniae infection and the limited antimicrobial options for treatment of carbapenem-resistant K. pneumoniae infection highlight the need for improved detection of carbapenem-resistant K. pneumoniae infection, identification of effective preventive measures, and development of novel agents with reliable clinical efficacy against carbapenem-resistant K. pneumoniae.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 12 , December 2008 , pp. 1099 - 1106
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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