title: KPC-producing Klebsiella pneumoniae enteric colonization acquired during intensive care unit stay: the significance of risk factors for its development and its impact on mortality.
abstract: A prospective observational study of 226 intensive care unit (ICU) patients was conducted during a 25-month period. Rectal samples were taken at day 1, 4, and 7 and, afterwards, once weekly. Klebsiella pneumoniae was identified using standard techniques, whereas the presence of bla(KPC) gene was confirmed by PCR. During ICU stay, 72.6% of the patients were colonized with Klebsiella pneumoniae carbapenemases (KPC)-producing K. pneumoniae (KPC-Kp). Male gender, prior bed occupants, and patients in nearby beds colonized with KPC-Kp, tracheotomy, number of invasive catheters inserted, and number of antibiotics administered were the major risk factors for KPC-Kp colonization. ICU mortality (35.4%) was significantly related to Simplified Acute Physiology II score and respiratory insufficiency upon admission, cortisone administration, aminoglycoside administration, confirmed KPC-Kp infection, and severe sepsis or septic shock. The high prevalence of KPC-Kp enteric carriage in ICU patients and the significant mortality associated with KPC-Kp infection dictate the importance of early identification and isolation of such carriers.
authors.affiliation: Division of Infectious Diseases, Internal Medicine, School of Medicine, University of Patras, Patras, Greece; Department of Microbiology, School of Medicine, University of Patras, Patras, Greece.
authors.forename: Matthaios
authors.initials: M
authors.lastname: Papadimitriou-Olivgeris
authors.forename: Markos
authors.initials: M
authors.lastname: Marangos
authors.forename: Fotini
authors.initials: F
authors.lastname: Fligou
authors.forename: Myrto
authors.initials: M
authors.lastname: Christofidou
authors.forename: Christina
authors.initials: C
authors.lastname: Sklavou
authors.forename: Sophia
authors.initials: S
authors.lastname: Vamvakopoulou
authors.forename: Evangelos D
authors.initials: ED
authors.lastname: Anastassiou
authors.forename: Kriton S
authors.initials: KS
authors.lastname: Filos
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000235:genetics; D002353:Carrier State / Q000188:drug therapy / Q000382:microbiology*; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007710:Klebsiella Infections / Q000188:drug therapy / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases
keywords: Carriage; Critically ill patients; Resistance; Surveillance