Risk factors and clinical impact of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae.
BACKGROUND
Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae is an emerging pathogen with serious clinical and infection control implications. To our knowledge, no study has specifically examined risk factors for KPC-producing K. pneumoniae or its impact on mortality.


METHODS
To identify risk factors for infection or colonization with KPC-producing K. pneumoniae, a case-control study was performed. Case patients with KPC-producing K. pneumoniae were compared with control subjects with carbapenem-susceptible K. pneumoniae. A cohort study evaluated the association between KPC-producing K. pneumoniae and in-hospital mortality.


RESULTS
Fifty-six case patients and 863 control subjects were identified. In multivariable analysis, independent risk factors for KPC-producing K. pneumoniae were (1) severe illness (adjusted odds ratio [AOR], 4.31; 95% confidence interval [CI], 2.25-8.25), (2) prior fluoroquinolone use (AOR, 3.39; 95% CI, 1.50, 7.66), and (3) prior extended-spectrum cephalosporin use (AOR, 2.55; 95% CI, 1.18, 5.52). Compared with samples from other anatomic locations, K. pneumoniae isolates from blood samples were less likely to harbor KPC (AOR, 0.33; 95% CI, 0.12, 0.86). KPC-producing K. pneumoniae was independently associated with in-hospital mortality (AOR, 3.60; 95% CI, 1.87-6.91).


CONCLUSIONS
KPC-producing K. pneumoniae is an emerging pathogen associated with significant mortality. Our findings highlight the urgent need to develop strategies for prevention and infection control. Limiting use of certain antimicrobials, specifically fluoroquinolones and cephalosporins, use may be effective strategies.
Division of Infectious Diseases, Department of Medicine, and the Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. leanne.gasink@astrazeneca.com
Leanne B
LB
Gasink
Paul H
PH
Edelstein
Ebbing
E
Lautenbach
Marie
M
Synnestvedt
Neil O
NO
Fishman
D001426:Bacterial Proteins / Q000096:biosynthesis*; D016022:Case-Control Studies; D015331:Cohort Studies; D003428:Cross Infection / Q000382:microbiology; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology / Q000472:pathogenicity*; D008297:Male; D012307:Risk Factors; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000096:biosynthesis*
D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase; C531581:carbapenemase-2, Klebsiella pneumoniae