title: Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies.
abstract: BACKGROUND
  Carbapenem-resistant Klebsiella pneumoniae is an emerging healthcare-associated pathogen.
  
  
  OBJECTIVE
  To describe the epidemiology of and clinical outcomes associated with carbapenem-resistant K. pneumoniae infection and to identify risk factors associated with mortality among patients with this type of infection.
  
  
  METHODS
  Mount Sinai Hospital, a 1,171-bed tertiary care teaching hospital in New York City.
  
  
  METHODS
  Two matched case-control studies.
  
  
  METHODS
  In the first matched case-control study, case patients with carbapenem-resistant K. pneumoniae infection were compared with control patients with carbapenem-susceptible K. pneumoniae infection. In the second case-control study, patients who survived carbapenem-resistant K. pneumoniae infection were compared with those who did not survive, to identify risk factors associated with mortality among patients with carbapenem-resistant K. pneumoniae infection.
  
  
  RESULTS
  There were 99 case patients and 99 control patients identified. Carbapenem-resistant K. pneumoniae infection was independently associated with recent organ or stem-cell transplantation (P=.008), receipt of mechanical ventilation (P=.04), longer length of stay before infection (P=.01), and exposure to cephalosporins (P=.02) and carbapenems (P<.001). Case patients were more likely than control patients to die during hospitalization (48% vs 20%; P<.001) and to die from infection (38% vs 12%; P<.001). Removal of the focus of infection (ie, debridement) was independently associated with patient survival (P=.002). The timely administration of antibiotics with in vitro activity against carbapenem-resistant K. pneumoniae was not associated with patient survival.
  
  
  CONCLUSIONS
  Carbapenem-resistant K. pneumoniae infection is associated with numerous healthcare-related risk factors and with high mortality. The mortality rate associated with carbapenem-resistant K. pneumoniae infection and the limited antimicrobial options for treatment of carbapenem-resistant K. pneumoniae infection highlight the need for improved detection of carbapenem-resistant K. pneumoniae infection, identification of effective preventive measures, and development of novel agents with reliable clinical efficacy against carbapenem-resistant K. pneumoniae.
authors.affiliation: Department of Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA.
authors.forename: Gopi
authors.initials: G
authors.lastname: Patel
authors.forename: Shirish
authors.initials: S
authors.lastname: Huprikar
authors.forename: Stephanie H
authors.initials: SH
authors.lastname: Factor
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Jenkins
authors.forename: David P
authors.initials: DP
authors.lastname: Calfee
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D015780:Carbapenems; D016022:Case-Control Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D015780:Carbapenems