title: Co-colonization with carbapenem-resistant Klebsiella pneumoniae and Acinetobacter baumannii in intensive care unit patients.
abstract: OBJECTIVE
  This investigation was conducted to study co-colonization by carbapenem-resistant Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) and Acinetobacter baumannii (CRAB) in intensive care unit (ICU) patients in Palermo, Sicily, a geographic area where both organisms are endemic in the healthcare setting. Risk factors at admission and during ICU stay and outcomes were also evaluated.
  
  
  METHODS
  All patients colonized by KPC-Kp, or CRAB, or both in 2 ICUs of a large general hospital during the period October 2011-March 2012 were enrolled. Demographics and clinical data were collected. Resistance determinants and clonality of the 2 organisms were characterized by molecular methods.
  
  
  RESULTS
  Seventy-five of 391 patients (19.2%) proved to be colonized by KPC-Kp, CRAB, or both: 30 (40%) were co-colonized and 44 (58.7%) were mono-colonized by CRAB and 1 by KPC-Kp. Younger age, major trauma, and length of stay were positively associated with co-colonization. However, no significant differences were detected between co-colonized and non co-colonized patients in infection and ICU mortality rates and length of stay after the first isolation. Both organisms proved to be circulating in a clonal way.
  
  
  CONCLUSIONS
  In our setting, co-colonization by KPC-Kp and CRAB disproportionately affected young trauma patients with those with a prolonged ICU stay.
authors.affiliation: Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy. caterina.mammina@unipa.it
authors.forename: Caterina
authors.initials: C
authors.lastname: Mammina
authors.forename: Celestino
authors.initials: C
authors.lastname: Bonura
authors.forename: Anna Rita
authors.initials: AR
authors.lastname: Vivoli
authors.forename: Francesca
authors.initials: F
authors.lastname: Di Bernardo
authors.forename: Concetta
authors.initials: C
authors.lastname: Sodano
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Saporito
authors.forename: Maria Stella
authors.initials: MS
authors.lastname: Verde
authors.forename: Laura
authors.initials: L
authors.lastname: Saporito
authors.forename: Andrea Neville
authors.initials: AN
authors.lastname: Cracchiolo
authors.forename: Pier Giorgio
authors.initials: PG
authors.lastname: Fabbri
authors.forename: Romano
authors.initials: R
authors.lastname: Tetamo
authors.forename: Daniela Maria
authors.initials: DM
authors.lastname: Palma
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology* / Q000382:microbiology; D040981:Acinetobacter baumannii / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001426:Bacterial Proteins / Q000235:genetics / Q000378:metabolism*; D060085:Coinfection / Q000453:epidemiology* / Q000382:microbiology; D016638:Critical Illness; D024881:Drug Resistance, Bacterial; D005260:Female; D005838:Genotype; D006769:Hospitals, General; D006801:Humans; D007362:Intensive Care Units; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D058889:Molecular Typing; D012307:Risk Factors; D012802:Sicily / Q000453:epidemiology; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase