A Hoxha1, T Kärki2, C Giambi2, C Montano2, A Sisto3, A Bella4, F D'Ancona4. 1. Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: ana.hoxha489@gmail.com. 2. Istituto Superiore di Sanità (ISS), National Centre for Epidemiology Surveillance and Health Promotion (CNESPS), Rome, Italy; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden. 3. Ospedale Bambino Gesù, Rome, Italy. 4. Istituto Superiore di Sanità (ISS), National Centre for Epidemiology Surveillance and Health Promotion (CNESPS), Rome, Italy.
Abstract
BACKGROUND: In Italy, infections with carbapenem-resistant Klebsiella pneumoniae (CRKP) have increased markedly since 2009, creating unprecedented problems in healthcare settings and limiting treatment options for infected patients. AIM: To assess the attributable mortality due to CRKP in ten Italian hospitals and to describe the clinical characteristics of patients with an invasive CRKP and carbapenem-susceptible K. pneumoniae (CSKP) infection. METHODS: We conducted a matched cohort study, and calculated crude and attributable mortality for CRKP. The attributable mortality was calculated by subtracting the crude mortality rate of the patients with CSKP from the crude mortality rate of the patients with CRKP. We also described the clinical characteristics of CRKP and CSKP patients and analysed the determinants of mortality by using conditional Poisson regression. FINDINGS: The study included 98 patients, 49 with CRKP and 49 with CSKP. CRKP patients had undergone more invasive procedures and also tended to have more serious conditions, measured by higher Simplified Acute Physiology Score II. The attributable mortality of CRKP at 30 days was 41%. CRKP patients were three times more likely to die within 30 days [matched incidence rate ratio (mIRR): 3.0; 95% confidence interval (CI): 1.5-6.1]. Adjusting for potential confounders, the risk remained the same (adjusted mIRR: 3.0; 95% CI: 1.3-7.1). CONCLUSION: CRKP infection had a marked effect on patient mortality, even after adjusting for other patient characteristics. To control the spread of CRKP we recommend prioritization of control measures in hospitals where CRKP is found.
BACKGROUND: In Italy, infections with carbapenem-resistant Klebsiella pneumoniae (CRKP) have increased markedly since 2009, creating unprecedented problems in healthcare settings and limiting treatment options for infectedpatients. AIM: To assess the attributable mortality due to CRKP in ten Italian hospitals and to describe the clinical characteristics of patients with an invasive CRKP and carbapenem-susceptible K. pneumoniae (CSKP) infection. METHODS: We conducted a matched cohort study, and calculated crude and attributable mortality for CRKP. The attributable mortality was calculated by subtracting the crude mortality rate of the patients with CSKP from the crude mortality rate of the patients with CRKP. We also described the clinical characteristics of CRKP and CSKP patients and analysed the determinants of mortality by using conditional Poisson regression. FINDINGS: The study included 98 patients, 49 with CRKP and 49 with CSKP. CRKP patients had undergone more invasive procedures and also tended to have more serious conditions, measured by higher Simplified Acute Physiology Score II. The attributable mortality of CRKP at 30 days was 41%. CRKP patients were three times more likely to die within 30 days [matched incidence rate ratio (mIRR): 3.0; 95% confidence interval (CI): 1.5-6.1]. Adjusting for potential confounders, the risk remained the same (adjusted mIRR: 3.0; 95% CI: 1.3-7.1). CONCLUSION: CRKP infection had a marked effect on patient mortality, even after adjusting for other patient characteristics. To control the spread of CRKP we recommend prioritization of control measures in hospitals where CRKP is found.
Authors: Sameer S Kadri; Jeffrey R Strich; Bruce J Swihart; Samuel Hohmann; John P Dekker; Tara Palmore; Stephanie Bonne; Bradley Freeman; Jillian Raybould; Nirav G Shah; Devang Patel; Jennifer Husson; Mitchell D Jacobs; Lan Duong; Dean Follmann; David C Hooper; Joseph Timpone; Robert L Danner Journal: Am J Infect Control Date: 2019-02-27 Impact factor: 2.918
Authors: M L Cristina; M Sartini; G Ottria; E Schinca; N Cenderello; M P Crisalli; P Fabbri; G Lo Pinto; D Usiglio; A M Spagnolo Journal: J Prev Med Hyg Date: 2016-09
Authors: David M Jacobs; M Courtney Safir; Dennis Huang; Faisal Minhaj; Adam Parker; Gauri G Rao Journal: Ann Clin Microbiol Antimicrob Date: 2017-11-25 Impact factor: 3.944