Carbapenem-resistant Klebsiella pneumoniae is associated with poor outcome in hemodialysis patients.
BACKGROUND
Hemodialysis (HD) units have become a source of resistant bacteria. One of the most alarming developments is the emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP). Risk factors and outcomes of CRKP isolation in HD patients have not been previously studied.


METHODS
A nested case-control study was conducted in maintenance HD patients between January 1st 2006 and June 30th 2009. CRKP-positive patients were matched with randomly selected CRKP-negative HD patients. Demographics, clinical and laboratory data were collected for 24 months prior to the specimen collection. Multivariate analyses identified independent risk factors for CRKP. A prospective follow-up determined CRKP-associated outcome.


RESULTS
Demographics associated with CRKP acquisition in HD patients were age between 65 and 75 and having no living offspring. Clinical conditions associated with CRKP were previous hospitalization, temporary HD catheter and previous isolation of vancomycin-resistant enterococcus. CRKP-related outcome was poor: median survival of one month and a hazard ratio [95% CI] of 5.9 [3.2-11.0] for mortality.


CONCLUSIONS
Temporary HD catheters and previous treatment for VRE may predict subsequent CRKP isolation. A microbiological diagnosis of CRKP in HD patients is highly associated with imminent mortality. Meticulous measures to control the spread of CRKP bacteria among HD patients appear particularly warranted.
Nephrology and Hypertension Services, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Dina
D
Bleumin
Matan J
MJ
Cohen
Olivier
O
Moranne
Vincent L M
VL
Esnault
Shmuel
S
Benenson
Ora
O
Paltiel
Keren
K
Tzukert
Irit
I
Mor-Yosef Levi
Iddo Z
IZ
Ben-Dov
Ronen
R
Levi
Aharon
A
Bloch
Yosef S
YS
Haviv
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015780:Carbapenems / Q000494:pharmacology*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000150:complications / Q000628:therapy; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D018440:beta-Lactam Resistance
D000900:Anti-Bacterial Agents; D015780:Carbapenems