OBJECTIVES: Patients undergoing major surgery are at increased risk of developing infections due to resistant organisms, including carbapenem-resistant Klebsiella pneumoniae (CR-Kp). In this study, we assessed risk factors for CR-Kp infections after open heart surgery in a teaching hospital in northern Italy. METHODS: A retrospective study was conducted from January to December 2014. The primary outcome measure was postoperative CR-Kp infection, defined as a time-to-event end-point. The effect of potentially related variables was assessed by univariable and multivariable analyses. Secondary end-points were in-hospital mortality and 180-day postoperative mortality. RESULTS: Among 553 patients undergoing open heart surgery, 32 developed CR-Kp infections (6%). In the final multivariable model, CR-Kp colonization [hazard ratio (HR) 227.45, 95% confidence intervals (CI) 67.13-1225.20, P < 0.001], cardiopulmonary bypass time in minutes (HR 1.01, 95% CI 1.01-1.02, P < 0.001), chronic obstructive pulmonary disease (HR 3.99, 95% CI 1.61-9.45, P = 0.004), SOFA score (HR 1.29, 95% CI 1.08-1.53, P = 0.007), preoperative mechanical ventilation (HR 8.10, 95% CI 1.31-48.57, P = 0.026), prolonged mechanical ventilation (HR 2.48, 95% CI 1.08-6.15, P = 0.032) and female sex (HR 2.08, 95% CI 1.00-4.36, P = 0.049) were associated with the development of CR-Kp infection. Increased in-hospital mortality and 180-day mortality were observed in patients who developed CR-Kp infections in comparison with those who did not. CONCLUSIONS: In our cohort, CR-Kp colonization was an important predictor of CR-Kp infection after open heart surgery. CR-Kp infection after surgery significantly affected survival. Preventing colonization is conceivably the most effective current strategy to reduce the impact of CR-Kp.
OBJECTIVES:Patients undergoing major surgery are at increased risk of developing infections due to resistant organisms, including carbapenem-resistant Klebsiella pneumoniae (CR-Kp). In this study, we assessed risk factors for CR-Kpinfections after open heart surgery in a teaching hospital in northern Italy. METHODS: A retrospective study was conducted from January to December 2014. The primary outcome measure was postoperative CR-Kpinfection, defined as a time-to-event end-point. The effect of potentially related variables was assessed by univariable and multivariable analyses. Secondary end-points were in-hospital mortality and 180-day postoperative mortality. RESULTS: Among 553 patients undergoing open heart surgery, 32 developed CR-Kpinfections (6%). In the final multivariable model, CR-Kp colonization [hazard ratio (HR) 227.45, 95% confidence intervals (CI) 67.13-1225.20, P < 0.001], cardiopulmonary bypass time in minutes (HR 1.01, 95% CI 1.01-1.02, P < 0.001), chronic obstructive pulmonary disease (HR 3.99, 95% CI 1.61-9.45, P = 0.004), SOFA score (HR 1.29, 95% CI 1.08-1.53, P = 0.007), preoperative mechanical ventilation (HR 8.10, 95% CI 1.31-48.57, P = 0.026), prolonged mechanical ventilation (HR 2.48, 95% CI 1.08-6.15, P = 0.032) and female sex (HR 2.08, 95% CI 1.00-4.36, P = 0.049) were associated with the development of CR-Kpinfection. Increased in-hospital mortality and 180-day mortality were observed in patients who developed CR-Kpinfections in comparison with those who did not. CONCLUSIONS: In our cohort, CR-Kp colonization was an important predictor of CR-Kpinfection after open heart surgery. CR-Kpinfection after surgery significantly affected survival. Preventing colonization is conceivably the most effective current strategy to reduce the impact of CR-Kp.
Authors: 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 Journal: Eur J Clin Microbiol Infect Dis Date: 2016-12-01 Impact factor: 3.267
Authors: Daniele Roberto Giacobbe; Antonio Salsano; Filippo Del Puente; Ambra Miette; Antonio Vena; Silvia Corcione; Michele Bartoletti; Alessandra Mularoni; Alberto Enrico Maraolo; Maddalena Peghin; Alessia Carnelutti; Angela Raffaella Losito; Francesca Raffaelli; Ivan Gentile; Beatrice Maccari; Stefano Frisone; Renato Pascale; Elisa Mikus; Alice Annalisa Medaglia; Elena Conoscenti; Davide Ricci; Tommaso Lupia; Marco Comaschi; Maddalena Giannella; Mario Tumbarello; Francesco Giuseppe De Rosa; Valerio Del Bono; Malgorzata Mikulska; Francesco Santini; Matteo Bassetti Journal: Open Forum Infect Dis Date: 2020-06-19 Impact factor: 3.835
Authors: Daniele Roberto Giacobbe; Antonio Salsano; Filippo Del Puente; Francesco Campanini; Giovanni Mariscalco; Anna Marchese; Claudio Viscoli; Francesco Santini Journal: Antibiotics (Basel) Date: 2019-08-28