Epidemiology, management, and outcome of carbapenem-resistant Klebsiella pneumoniae bloodstream infections in hospitals within the same endemic metropolitan area

• Published in: Journal of infection and public health Vol. 11; no. 2; pp. 171 - 177
• Main Authors: Cristina, Maria L., Alicino, Cristiano, Sartini, Marina, Faccio, Valeria, Spagnolo, Anna M., Bono, Valerio D., Cassola, Giovanni, De Mite, Anna M., Crisalli, Maria P., Ottria, Gianluca, Schinca, Elisa, Pinto, Giuliano L., Bottaro, Luigi C., Viscoli, Claudio, Orsi, Andrea, Giacobbe, Daniele R., Icardi, Giancarlo
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.03.2018; Elsevier
• Subjects: Aged; Bacteremia - drug therapy; Bacteremia - microbiology; Bloodstream infection; BSI; Carbapenem-resistant Klebsiella pneumoniae; Carbapenems - pharmacology; Carbapenems - therapeutic use; Cities; CRKP; Cross Infection - epidemiology; Cross Infection - microbiology; Disease Management; Drug Resistance, Bacterial; Epidemiology; Female; Hospitals - statistics & numerical data; Humans; Incidence; Italy - epidemiology; Klebsiella Infections - blood; Klebsiella Infections - epidemiology; Klebsiella Infections - mortality; Klebsiella pneumoniae - drug effects; Male; Middle Aged; Retrospective Studies; Risk Factors; Treatment Outcome; OR; EUCAST; Bloodstream infection; MICs; IQR; CRKP; Epidemiology; CVC; CR-Kp; LHU; Carbapenem-resistant Klebsiella pneumoniae; BSI; ICU; ID; 95% CI; COPD
• ISSN: 1876-0341; 1876-035X
• DOI: 10.1016/j.jiph.2017.06.003

In the last decade, carbapenem-resistant Klebsiella pneumoniae (CR-Kp) has become endemic in several countries, including Italy. In the present study, we assessed the differences in epidemiology, management, and mortality of CR-Kp bloodstream infection (BSI) in the three main adult acute-care hospitals of the metropolitan area of Genoa, Italy. From January 2013 to December 2014, all patients with CR-Kp BSI were identified through the computerized microbiology laboratory databases of the three hospitals. The primary endpoints of the study were incidence and characteristics of CR-Kp BSI in hospitals within the same endemic metropolitan area. Secondary endpoints were characteristics of CR-Kp BSI in hospitals with and without internal infectious diseases consultants (IDCs) and 15-day mortality. During the study period, the incidence of healthcare-associated CR-Kp BSI in the entire study population was 1.35 episodes per 10,000 patient-days, with substantial differences between the three hospitals. Patients admitted to the two hospital with internal IDCs were more likely to receive post-susceptibility test combined therapy including carbapenems (77% vs. 26%, p<0.001), adequate post-susceptibility test therapies (86% vs. 52%, p<0.001), and post-susceptibility therapies prescribed by an infectious diseases specialist (84% vs. 14%, p<0.001). Overall, the crude 15-days mortality was 26%. In the final multivariable model, only septic shock at BSI presentation was unfavorably and independently associated with 15-days mortality (odds ratio [OR] 6.7, 95% confidence intervals [CI] 2.6–17.6, p<0.001), while a protective effect was observed for post-susceptibility test combined therapies including a carbapenem (OR 0.11, 95% CI 0.03–0.43, p=0.002). Mortality of CR-Kp remains high. Differences in the incidence of CR-Kp BSI were detected between acute-care centers within the same endemic metropolitan area. Efforts should be made to improve the collaboration and coordination between centers, to prevent further diffusion of CR-Kp.