title: Attributable mortality rate for carbapenem-resistant Klebsiella pneumoniae bacteremia.
abstract: OBJECTIVE
  To determine the attributable (direct) mortality and morbidity caused by carbapenem-resistant Klebsiella pneumoniae bacteremia.
  
  
  METHODS
  A matched retrospective, historical cohort design, using a stepwise procedure to stringently match the best control subjects to the best case subjects.
  
  
  METHODS
  A 1,000-bed tertiary-care university teaching hospital.
  
  
  METHODS
  Case subjects were defined as adult patients with carbapenem-resistant K. pneumoniae bacteremia during the period from October 2005 through October 2008. Control subjects were defined as patients who were very similar to case subjects except that they did not have bacteremia.
  
  
  METHODS
  Matching potential control subjects to case subjects was performed at a 1:1 ratio using a computerized record system. The criteria used included same hospitalization period, similar Charlson comorbidity index, same underlying disease, same age within 10 years, and same sex. Demographic and clinical characteristics were collected from medical records.
  
  
  RESULTS
  During the study period, 319 patients developed an infection due to carbapenem-resistant K. pneumoniae. Of these 319 patients, 39 (12.2%) developed a bloodstream infection, for an overall rate of 0.59 episodes of carbapenem-resistant K. pneumoniae bacteremia per 10,000 patient-days. We excluded 7 patients from our study, leaving a total of 32 case subjects in our cohort. Case subjects were significantly more likely than control subjects (n = 32) to require care in an intensive care unit (12 case subjects [37.5%] vs 3 control subjects [9.4%]), ventilator support (17 case subjects [53.1%] vs 8 control subjects [25%]), and use of a central venous catheter (19 case subjects [59.4%] vs 9 control subjects [28.1%]). For case subjects, the crude mortality rate was 71.9% (ie, 23 of the 32 case subjects died); for control subjects, the crude mortality rate was 21.9% (ie, 7 of the 32 control subjects died) (P < .001. For case subjects, the attributable mortality was 50% (95% confidence interval [CI], 15.3%-98.6%). A mortality risk ratio of 3.3 (95% CI, 2.9-28.5) was found for case subjects with carbapenem-resistant K. pneumoniae bacteremia.
  
  
  CONCLUSIONS
  Patients with carbapenem-resistant K. pneumoniae require more intensive and invasive care. We have shown that the crude and attributable mortality rates associated with carbapenem-resistant K. pneumoniae bacteremia were striking.
authors.affiliation: Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel. borer07@nir.org.il
authors.forename: Abraham
authors.initials: A
authors.lastname: Borer
authors.forename: Lisa
authors.initials: L
authors.lastname: Saidel-Odes
authors.forename: Klaris
authors.initials: K
authors.lastname: Riesenberg
authors.forename: Seada
authors.initials: S
authors.lastname: Eskira
authors.forename: Nejama
authors.initials: N
authors.lastname: Peled
authors.forename: Ronit
authors.initials: R
authors.lastname: Nativ
authors.forename: Francisc
authors.initials: F
authors.lastname: Schlaeffer
authors.forename: Michael
authors.initials: M
authors.lastname: Sherf
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000382:microbiology / Q000401:mortality*; D015780:Carbapenems / Q000494:pharmacology*; D016022:Case-Control Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D007557:Israel / Q000453:epidemiology; D007710:Klebsiella Infections / Q000188:drug therapy / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000187:drug effects*; D008297:Male; D016555:Matched-Pair Analysis; D008826:Microbial Sensitivity Tests; D008875:Middle Aged
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems