Risk factors for carbapenem-resistant Klebsiella pneumoniae bloodstream infection among rectal carriers: a prospective observational multicentre study
Knowledge of carbapenem-resistant Klebsiella pneumoniae (CR-KP) colonization is important to prevent nosocomial spread but also to start prompt adequate antibiotic therapy in patients with suspicion of infection. However, few studies have examined the incidence and risk factors for CR-KP bloodstream...
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| Veröffentlicht in: | Clinical microbiology and infection 2014-12, Vol.20 (12), p.1357-1362 |
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| creator | Giannella, M. Trecarichi, E.M. De Rosa, F.G. Del Bono, V. Bassetti, M. Lewis, R.E. Losito, A.R. Corcione, S. Saffioti, C. Bartoletti, M. Maiuro, G. Cardellino, C.S. Tedeschi, S. Cauda, R. Viscoli, C. Viale, P. Tumbarello, M. |
| description | Knowledge of carbapenem-resistant Klebsiella pneumoniae (CR-KP) colonization is important to prevent nosocomial spread but also to start prompt adequate antibiotic therapy in patients with suspicion of infection. However, few studies have examined the incidence and risk factors for CR-KP bloodstream infection (BSI) among rectal carriers. To identify risk factors for CR-KP BSI among carriers, we performed a multicentre prospective matched case–control study of all adult CR-KP rectal carriers hospitalized in five tertiary teaching hospitals in Italy over a 2-year period. Carriers who developed CR-KP BSI were compared with those who did not develop subsequent BSI. Overall, 143 CR-KP BSIs were compared with 572 controls without a documented infection during their hospitalization. Multivariate analysis revealed that admission to the Intensive Care Unit (ICU) (OR, 1.65; 95% CI, 1.05–2.59; p 0.03), abdominal invasive procedure (OR, 1.87; 95% CI, 1.16–3.04; p 0.01), chemotherapy/radiation therapy (OR, 3.07; 95% CI, 1.78–5.29; p |
| doi_str_mv | 10.1111/1469-0691.12747 |
| format | Article |
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However, few studies have examined the incidence and risk factors for CR-KP bloodstream infection (BSI) among rectal carriers. To identify risk factors for CR-KP BSI among carriers, we performed a multicentre prospective matched case–control study of all adult CR-KP rectal carriers hospitalized in five tertiary teaching hospitals in Italy over a 2-year period. Carriers who developed CR-KP BSI were compared with those who did not develop subsequent BSI. Overall, 143 CR-KP BSIs were compared with 572 controls without a documented infection during their hospitalization. Multivariate analysis revealed that admission to the Intensive Care Unit (ICU) (OR, 1.65; 95% CI, 1.05–2.59; p 0.03), abdominal invasive procedure (OR, 1.87; 95% CI, 1.16–3.04; p 0.01), chemotherapy/radiation therapy (OR, 3.07; 95% CI, 1.78–5.29; p <0.0001), and number of additional colonization sites (OR, 3.37 per site; 95% CI, 2.56–4.43; p <0.0001) were independent risk factors for CR-KP BSI development among CR-KP rectal carriers. A CR-KP BSI risk score ranging from 0 to 28 was developed based on these four independent variables. At a cut-off of ≥2 the model exhibited a sensitivity, specificity, positive predictive value and negative predictive value of 93%, 42%, 29% and 93%, respectively. Colonization at multiple sites with CR-KP was the strongest predictor of BSI development in our large cohort of CR-KP rectal carriers.</description><identifier>ISSN: 1198-743X</identifier><identifier>EISSN: 1469-0691</identifier><identifier>DOI: 10.1111/1469-0691.12747</identifier><identifier>PMID: 24980276</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents - pharmacology ; beta-Lactam Resistance ; Bloodstream infection ; carbapenem resistance ; Carbapenems - pharmacology ; Carrier State - epidemiology ; Carrier State - microbiology ; Case-Control Studies ; colonization status ; Female ; Hospitals, Teaching ; Humans ; Incidence ; Infections ; Italy - epidemiology ; Klebsiella Infections - epidemiology ; Klebsiella Infections - microbiology ; Klebsiella pneumoniae ; Klebsiella pneumoniae - drug effects ; Klebsiella pneumoniae - isolation & purification ; Male ; Medical research ; Middle Aged ; Multivariate analysis ; Prospective Studies ; rectal carriers ; Rectum - microbiology ; Risk Factors ; Tertiary Care Centers ; Young Adult</subject><ispartof>Clinical microbiology and infection, 2014-12, Vol.20 (12), p.1357-1362</ispartof><rights>2014 European Society of Clinical Infectious Diseases</rights><rights>2014 The Authors Clinical Microbiology and Infection © 2014 European Society of Clinical Microbiology and Infectious Diseases</rights><rights>2014 The Authors Clinical Microbiology and Infection © 2014 European Society of Clinical Microbiology and Infectious Diseases.</rights><rights>Copyright © 2014 European Society of Clinical Microbiology and Infectious Diseases</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4957-63ac8c5d69cce3044a39aedd601d2a6b96e14befeb87320df0ace2363aab41673</citedby><cites>FETCH-LOGICAL-c4957-63ac8c5d69cce3044a39aedd601d2a6b96e14befeb87320df0ace2363aab41673</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2F1469-0691.12747$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2F1469-0691.12747$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24980276$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Giannella, M.</creatorcontrib><creatorcontrib>Trecarichi, E.M.</creatorcontrib><creatorcontrib>De Rosa, F.G.</creatorcontrib><creatorcontrib>Del Bono, V.</creatorcontrib><creatorcontrib>Bassetti, M.</creatorcontrib><creatorcontrib>Lewis, R.E.</creatorcontrib><creatorcontrib>Losito, A.R.</creatorcontrib><creatorcontrib>Corcione, S.</creatorcontrib><creatorcontrib>Saffioti, C.</creatorcontrib><creatorcontrib>Bartoletti, M.</creatorcontrib><creatorcontrib>Maiuro, G.</creatorcontrib><creatorcontrib>Cardellino, C.S.</creatorcontrib><creatorcontrib>Tedeschi, S.</creatorcontrib><creatorcontrib>Cauda, R.</creatorcontrib><creatorcontrib>Viscoli, C.</creatorcontrib><creatorcontrib>Viale, P.</creatorcontrib><creatorcontrib>Tumbarello, M.</creatorcontrib><title>Risk factors for carbapenem-resistant Klebsiella pneumoniae bloodstream infection among rectal carriers: a prospective observational multicentre study</title><title>Clinical microbiology and infection</title><addtitle>Clin Microbiol Infect</addtitle><description>Knowledge of carbapenem-resistant Klebsiella pneumoniae (CR-KP) colonization is important to prevent nosocomial spread but also to start prompt adequate antibiotic therapy in patients with suspicion of infection. However, few studies have examined the incidence and risk factors for CR-KP bloodstream infection (BSI) among rectal carriers. To identify risk factors for CR-KP BSI among carriers, we performed a multicentre prospective matched case–control study of all adult CR-KP rectal carriers hospitalized in five tertiary teaching hospitals in Italy over a 2-year period. Carriers who developed CR-KP BSI were compared with those who did not develop subsequent BSI. Overall, 143 CR-KP BSIs were compared with 572 controls without a documented infection during their hospitalization. Multivariate analysis revealed that admission to the Intensive Care Unit (ICU) (OR, 1.65; 95% CI, 1.05–2.59; p 0.03), abdominal invasive procedure (OR, 1.87; 95% CI, 1.16–3.04; p 0.01), chemotherapy/radiation therapy (OR, 3.07; 95% CI, 1.78–5.29; p <0.0001), and number of additional colonization sites (OR, 3.37 per site; 95% CI, 2.56–4.43; p <0.0001) were independent risk factors for CR-KP BSI development among CR-KP rectal carriers. A CR-KP BSI risk score ranging from 0 to 28 was developed based on these four independent variables. At a cut-off of ≥2 the model exhibited a sensitivity, specificity, positive predictive value and negative predictive value of 93%, 42%, 29% and 93%, respectively. Colonization at multiple sites with CR-KP was the strongest predictor of BSI development in our large cohort of CR-KP rectal carriers.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents - pharmacology</subject><subject>beta-Lactam Resistance</subject><subject>Bloodstream infection</subject><subject>carbapenem resistance</subject><subject>Carbapenems - pharmacology</subject><subject>Carrier State - epidemiology</subject><subject>Carrier State - microbiology</subject><subject>Case-Control Studies</subject><subject>colonization status</subject><subject>Female</subject><subject>Hospitals, Teaching</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infections</subject><subject>Italy - epidemiology</subject><subject>Klebsiella Infections - epidemiology</subject><subject>Klebsiella Infections - microbiology</subject><subject>Klebsiella pneumoniae</subject><subject>Klebsiella pneumoniae - drug effects</subject><subject>Klebsiella pneumoniae - isolation & purification</subject><subject>Male</subject><subject>Medical research</subject><subject>Middle Aged</subject><subject>Multivariate analysis</subject><subject>Prospective Studies</subject><subject>rectal carriers</subject><subject>Rectum - microbiology</subject><subject>Risk Factors</subject><subject>Tertiary Care Centers</subject><subject>Young Adult</subject><issn>1198-743X</issn><issn>1469-0691</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkUuLFDEUhYMozji6dicBN25qJqmkUhV30ugotgii4C7kcUsyViVtUtXSf8TfO4k9MwtBNJu8vnO49x6EnlJyTsu6oFzIhghJz2nb8_4eOr17uV_OVA5Nz9nXE_Qo5ytCSMsYf4hOWi4H0vbiFP365PN3PGq7xJTxGBO2Ohm9gwBzkyD7vOiw4PcTmOxhmjTeBVjnGLwGbKYYXV4S6Bn7MIJdfAxYl99vOJWbnqpb8pDyS1yUKeZdhfaAo8mQ9roKCjWv0-IthGKF87K6w2P0YNRThic3-xn68ub1583bZvvx8t3m1baxXHZ9I5i2g-2ckNYCI5xrJjU4Jwh1rRZGCqDcwAhm6FlL3Ei0hZYVmTacip6doRdH31LbjxXyomafbe0zQFyzoqLjQgy0pf-BcsLKTFlFn_-BXsU1lUYrxYZBdsW1UBdHypa55ASj2iU_63RQlKiarqpZqpql-p1uUTy78V3NDO6Ov42zAN0R-OknOPzLT222H26N5VEHZdb7kpfK1kOw4HzNUbno_1rUNWIIxSQ</recordid><startdate>201412</startdate><enddate>201412</enddate><creator>Giannella, M.</creator><creator>Trecarichi, E.M.</creator><creator>De Rosa, F.G.</creator><creator>Del Bono, V.</creator><creator>Bassetti, M.</creator><creator>Lewis, R.E.</creator><creator>Losito, A.R.</creator><creator>Corcione, S.</creator><creator>Saffioti, C.</creator><creator>Bartoletti, M.</creator><creator>Maiuro, G.</creator><creator>Cardellino, C.S.</creator><creator>Tedeschi, S.</creator><creator>Cauda, R.</creator><creator>Viscoli, C.</creator><creator>Viale, P.</creator><creator>Tumbarello, M.</creator><general>Elsevier Ltd</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>7X8</scope></search><sort><creationdate>201412</creationdate><title>Risk factors for carbapenem-resistant Klebsiella pneumoniae bloodstream infection among rectal carriers: a prospective observational multicentre study</title><author>Giannella, M. ; Trecarichi, E.M. ; De Rosa, F.G. ; Del Bono, V. ; Bassetti, M. ; Lewis, R.E. ; Losito, A.R. ; Corcione, S. ; Saffioti, C. ; Bartoletti, M. ; Maiuro, G. ; Cardellino, C.S. ; Tedeschi, S. ; Cauda, R. ; Viscoli, C. ; Viale, P. ; Tumbarello, M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4957-63ac8c5d69cce3044a39aedd601d2a6b96e14befeb87320df0ace2363aab41673</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Bacterial Agents - pharmacology</topic><topic>beta-Lactam Resistance</topic><topic>Bloodstream infection</topic><topic>carbapenem resistance</topic><topic>Carbapenems - pharmacology</topic><topic>Carrier State - epidemiology</topic><topic>Carrier State - microbiology</topic><topic>Case-Control Studies</topic><topic>colonization status</topic><topic>Female</topic><topic>Hospitals, Teaching</topic><topic>Humans</topic><topic>Incidence</topic><topic>Infections</topic><topic>Italy - epidemiology</topic><topic>Klebsiella Infections - epidemiology</topic><topic>Klebsiella Infections - microbiology</topic><topic>Klebsiella pneumoniae</topic><topic>Klebsiella pneumoniae - drug effects</topic><topic>Klebsiella pneumoniae - isolation & purification</topic><topic>Male</topic><topic>Medical research</topic><topic>Middle Aged</topic><topic>Multivariate analysis</topic><topic>Prospective Studies</topic><topic>rectal carriers</topic><topic>Rectum - microbiology</topic><topic>Risk Factors</topic><topic>Tertiary Care Centers</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Giannella, M.</creatorcontrib><creatorcontrib>Trecarichi, E.M.</creatorcontrib><creatorcontrib>De Rosa, F.G.</creatorcontrib><creatorcontrib>Del Bono, V.</creatorcontrib><creatorcontrib>Bassetti, M.</creatorcontrib><creatorcontrib>Lewis, R.E.</creatorcontrib><creatorcontrib>Losito, A.R.</creatorcontrib><creatorcontrib>Corcione, S.</creatorcontrib><creatorcontrib>Saffioti, C.</creatorcontrib><creatorcontrib>Bartoletti, M.</creatorcontrib><creatorcontrib>Maiuro, G.</creatorcontrib><creatorcontrib>Cardellino, C.S.</creatorcontrib><creatorcontrib>Tedeschi, S.</creatorcontrib><creatorcontrib>Cauda, R.</creatorcontrib><creatorcontrib>Viscoli, C.</creatorcontrib><creatorcontrib>Viale, P.</creatorcontrib><creatorcontrib>Tumbarello, M.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical microbiology and infection</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Giannella, M.</au><au>Trecarichi, E.M.</au><au>De Rosa, F.G.</au><au>Del Bono, V.</au><au>Bassetti, M.</au><au>Lewis, R.E.</au><au>Losito, A.R.</au><au>Corcione, S.</au><au>Saffioti, C.</au><au>Bartoletti, M.</au><au>Maiuro, G.</au><au>Cardellino, C.S.</au><au>Tedeschi, S.</au><au>Cauda, R.</au><au>Viscoli, C.</au><au>Viale, P.</au><au>Tumbarello, M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk factors for carbapenem-resistant Klebsiella pneumoniae bloodstream infection among rectal carriers: a prospective observational multicentre study</atitle><jtitle>Clinical microbiology and infection</jtitle><addtitle>Clin Microbiol Infect</addtitle><date>2014-12</date><risdate>2014</risdate><volume>20</volume><issue>12</issue><spage>1357</spage><epage>1362</epage><pages>1357-1362</pages><issn>1198-743X</issn><eissn>1469-0691</eissn><abstract>Knowledge of carbapenem-resistant Klebsiella pneumoniae (CR-KP) colonization is important to prevent nosocomial spread but also to start prompt adequate antibiotic therapy in patients with suspicion of infection. However, few studies have examined the incidence and risk factors for CR-KP bloodstream infection (BSI) among rectal carriers. To identify risk factors for CR-KP BSI among carriers, we performed a multicentre prospective matched case–control study of all adult CR-KP rectal carriers hospitalized in five tertiary teaching hospitals in Italy over a 2-year period. Carriers who developed CR-KP BSI were compared with those who did not develop subsequent BSI. Overall, 143 CR-KP BSIs were compared with 572 controls without a documented infection during their hospitalization. Multivariate analysis revealed that admission to the Intensive Care Unit (ICU) (OR, 1.65; 95% CI, 1.05–2.59; p 0.03), abdominal invasive procedure (OR, 1.87; 95% CI, 1.16–3.04; p 0.01), chemotherapy/radiation therapy (OR, 3.07; 95% CI, 1.78–5.29; p <0.0001), and number of additional colonization sites (OR, 3.37 per site; 95% CI, 2.56–4.43; p <0.0001) were independent risk factors for CR-KP BSI development among CR-KP rectal carriers. A CR-KP BSI risk score ranging from 0 to 28 was developed based on these four independent variables. At a cut-off of ≥2 the model exhibited a sensitivity, specificity, positive predictive value and negative predictive value of 93%, 42%, 29% and 93%, respectively. Colonization at multiple sites with CR-KP was the strongest predictor of BSI development in our large cohort of CR-KP rectal carriers.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>24980276</pmid><doi>10.1111/1469-0691.12747</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Clinical microbiology and infection, 2014-12, Vol.20 (12), p.1357-1362 |
| issn | 1198-743X 1469-0691 |
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| source | Wiley-Blackwell Journals; MEDLINE; Alma/SFX Local Collection; EZB Electronic Journals Library |
| subjects | Adolescent Adult Aged Aged, 80 and over Anti-Bacterial Agents - pharmacology beta-Lactam Resistance Bloodstream infection carbapenem resistance Carbapenems - pharmacology Carrier State - epidemiology Carrier State - microbiology Case-Control Studies colonization status Female Hospitals, Teaching Humans Incidence Infections Italy - epidemiology Klebsiella Infections - epidemiology Klebsiella Infections - microbiology Klebsiella pneumoniae Klebsiella pneumoniae - drug effects Klebsiella pneumoniae - isolation & purification Male Medical research Middle Aged Multivariate analysis Prospective Studies rectal carriers Rectum - microbiology Risk Factors Tertiary Care Centers Young Adult |
| title | Risk factors for carbapenem-resistant Klebsiella pneumoniae bloodstream infection among rectal carriers: a prospective observational multicentre study |
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