title: Risk factors and outcomes associated with acquisition of colistin-resistant KPC-producing Klebsiella pneumoniae: a matched case-control study.
abstract: A matched 1:3 case-control study investigated factors predicting colistin-resistant versus colistin-susceptible KPC-producing Klebsiella pneumoniae acquisition and its impact on patient outcomes. Case patients were more often admitted from other institutions (P = 0.019) and had longer therapy with beta-lactam/beta-lactamase inhibitors (P = 0.002) and higher overall mortality (P = 0.05). All 52 study isolates were clonally related, suggesting horizontal dissemination. None of these parameters independently predicted colistin resistance, which probably occurred in a susceptible KPC-KP strain that was subsequently disseminated horizontally.
authors.affiliation: Department of Microbiology, Tzaneio General Hospital, Piraeus, Greece.
authors.forename: Olympia
authors.initials: O
authors.lastname: Zarkotou
authors.forename: Spyros
authors.initials: S
authors.lastname: Pournaras
authors.forename: Evangelia
authors.initials: E
authors.lastname: Voulgari
authors.forename: Georgios
authors.initials: G
authors.lastname: Chrysos
authors.forename: Athanassios
authors.initials: A
authors.lastname: Prekates
authors.forename: Dionysios
authors.initials: D
authors.lastname: Voutsinas
authors.forename: Katerina
authors.initials: K
authors.lastname: Themeli-Digalaki
authors.forename: Athanassios
authors.initials: A
authors.lastname: Tsakris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000096:biosynthesis*; D015373:Bacterial Typing Techniques; D016022:Case-Control Studies; D016000:Cluster Analysis; D003091:Colistin / Q000494:pharmacology*; D016172:DNA Fingerprinting; D004269:DNA, Bacterial / Q000235:genetics; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005838:Genotype; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000145:classification* / Q000302:isolation & purification / Q000472:pathogenicity*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D004269:DNA, Bacterial; D001618:beta-Lactamases; D003091:Colistin