Ángela Cano1, Belén Gutiérrez-Gutiérrez2, Isabel Machuca1, Julián Torre-Giménez3, Azahara Frutos-Adame3, Manuel García-Gutiérrez3, Marina Gallo-Marín3, Irene Gracia-Ahufinger4, María J Artacho4, Alejandra M Natera1, Elena Pérez-Nadales1, Juan José Castón1, Sabrina Mameli5, Francisco Gómez-Delgado6, Carmen de la Fuente7, Inmaculada Salcedo8, Jesús Rodríguez-Baño9, Luis Martínez-Martínez10, Julián Torre-Cisneros11. 1. Infectious Diseases Service, Hospital Universitario Reina Sofía-Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain; Spanish Network of Research in Infectious Diseases (REIPI). 2. Infectious Diseases Service, Hospital Universitario Virgen Macarena-Instituto de Biomedicina de Sevilla (IBiS) and Department of Medicine, Universidad de Sevilla, Seville, Spain; Spanish Network of Research in Infectious Diseases (REIPI). Electronic address: belengutiguti@hotmail.com. 3. Infectious Diseases Service, Hospital Universitario Reina Sofía-Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain. 4. Unit of Microbiology, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain; Spanish Network of Research in Infectious Diseases (REIPI). 5. Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy. 6. Internal Medicine Service, Hospital Universitario Reina Sofía-IMIBIC, Córdoba, Spain. 7. Intensive Care Service, Hospital Universitario Reina Sofía-IMIBIC, Córdoba, Spain. 8. Preventive Medicine Service, Hospital Universitario Reina Sofía-IMIBIC, Córdoba, Spain. 9. Infectious Diseases Service, Hospital Universitario Virgen Macarena-Instituto de Biomedicina de Sevilla (IBiS) and Department of Medicine, Universidad de Sevilla, Seville, Spain; Spanish Network of Research in Infectious Diseases (REIPI). 10. Unit of Microbiology Service, Hospital Universitario Reina Sofía-IMIBIC; Department of Agricultural Chemistry, Edafology and Microbiology, Universidad de Córdoba; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)-Universidad de Córdoba, Córdoba, Spain; Spanish Network of Research in Infectious Diseases (REIPI). 11. Infectious Diseases Service, Hospital Universitario Reina Sofía-Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain; Spanish Network of Research in Infectious Diseases (REIPI). Electronic address: julian.torre.sspa@juntadeandalucia.es.
Abstract
OBJECTIVES: We evaluated the association of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) rectal colonisation with crude mortality and whether this association is independent of the risk of KPC-Kp infection. METHODS: This was a prospective cohort study of patients followed-up 90 days after a study of rectal colonisation. Cox regression was used to study the variables associated with crude mortality. Sensitivity analyses for 90-day crude mortality in different subcohorts were performed. RESULTS: A total of 1244 patients (1078 non-colonised and 166 colonised) were included. None of the non-colonised patients and 78 (47.0%) of the colonised patients developed KPC-Kp infection. The 90-day crude mortality was 18.0% (194/1078) in non-colonised patients and 41.6% (69/166) in colonised patients. Rectal colonisation was not associated with crude mortality [hazard ratio (HR) = 1.03, 95% confidence interval (CI) 0.69-1.54; P = 0.85] when the model was adjusted for severe KPC-Kp infection [INCREMENT-CPE score (ICS) > 7]. KPC-Kp infection with ICS > 7 was associated with an increased risk of all-cause mortality (HR = 2.21, 95% CI 1.35-3.63; P = 0.002). In the sensitivity analyses, KPC-Kp colonisation was not associated with mortality in any of the analysed subcohorts, including patients who did not develop KPC-Kp infection (HR = 0.93, 95% CI 0.60-1.43; P = 0.74). CONCLUSION: KPC-Kp rectal colonisation was not associated with crude mortality. Mortality increased when colonised patients developed severe KPC-Kp infection (ICS > 7). Rectal colonisation was a necessary although insufficient condition to die from a KPC-Kp infection.
OBJECTIVES: We evaluated the association of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) rectal colonisation with crude mortality and whether this association is independent of the risk of KPC-Kp infection. METHODS: This was a prospective cohort study of patients followed-up 90 days after a study of rectal colonisation. Cox regression was used to study the variables associated with crude mortality. Sensitivity analyses for 90-day crude mortality in different subcohorts were performed. RESULTS: A total of 1244 patients (1078 non-colonised and 166 colonised) were included. None of the non-colonised patients and 78 (47.0%) of the colonised patients developed KPC-Kp infection. The 90-day crude mortality was 18.0% (194/1078) in non-colonised patients and 41.6% (69/166) in colonised patients. Rectal colonisation was not associated with crude mortality [hazard ratio (HR) = 1.03, 95% confidence interval (CI) 0.69-1.54; P = 0.85] when the model was adjusted for severe KPC-Kp infection [INCREMENT-CPE score (ICS) > 7]. KPC-Kp infection with ICS > 7 was associated with an increased risk of all-cause mortality (HR = 2.21, 95% CI 1.35-3.63; P = 0.002). In the sensitivity analyses, KPC-Kp colonisation was not associated with mortality in any of the analysed subcohorts, including patients who did not develop KPC-Kp infection (HR = 0.93, 95% CI 0.60-1.43; P = 0.74). CONCLUSION: KPC-Kp rectal colonisation was not associated with crude mortality. Mortality increased when colonised patients developed severe KPC-Kp infection (ICS > 7). Rectal colonisation was a necessary although insufficient condition to die from a KPC-Kp infection.
Authors: Elena Pérez-Nadales; Alejandra M Natera; Manuel Recio-Rufián; Julia Guzmán-Puche; Juan Antonio Marín-Sanz; Carlos Martín-Pérez; Ángela Cano; Juan José Castón; Cristina Elías-López; Isabel Machuca; Belén Gutiérrez-Gutiérrez; Luis Martínez-Martínez; Julián Torre-Cisneros Journal: Microbiol Spectr Date: 2022-06-29