title: Emergence of carbapenem-resistant Klebsiella spp. infections in a Turkish university hospital: epidemiology and risk factors.
abstract: BACKGROUND
  Risk factors for nosocomial carbapenem-resistant Klebsiella spp. (CRK) infections were analyzed in this study.
  
  
  METHODS
  The incidence, clinical characteristics, risk factors, antimicrobial susceptibility, and outcomes of CRK infections during a seven-year period (2004-2010) were retrospectively analyzed.
  
  
  RESULTS
  A total of 720 patients were included in the study. Carbapenem resistance among Klebsiella spp. were significantly increased between 2003 and 2007 (p<0.001). CRK strains were mostly isolated from ICUs (p<0.001). Use of imipenem and cefoperazone-sulbactam within prior three months, stay in ICU, receiving immunspressive therapy, receiving H2 receptor antagonists, tracheostomy, mechanical ventilation, hemodialysis, urinary catheter were found to be significant risk factors for carbapenem resistance Klebsiella spp. infections. In a multivariate analysis, prior use of imipenem (OR 3.35; CI 1.675-6.726, p<0.001), stay in ICU (OR 3.36; 95% CI 1.193-9.508; p=0.022), receiving H2 receptor antagonist (OR 4.49; 95% CI 1.011-19.951; p=0.048) were independently associated with carbapenem resistance. Respiratory tract infections were the most seen nosocomial infection. Attack mortality rate was significantly higher in patients infected with CRK strains (p<0.001). CRK strains showed significantly higher resistance rates to other antibiotics.
  
  
  CONCLUSIONS
  In conclusion, the emergence and rapid spread of CRK strains in our hospital is worrisome. The patients in ICU are most important risk group for the acquisition of CRK strains. High resistant rates to other antibiotics except than colistin and tigecycline limits therapeutic options, and increases mortality rates.
authors.affiliation: Gazi University Faculty of Medicine. muratdizbay@gazi.edu.tr.
authors.forename: Murat
authors.initials: M
authors.lastname: Dizbay
authors.forename: Ozlem
authors.initials: O
authors.lastname: Guzel Tunccan
authors.forename: Omer
authors.initials: O
authors.lastname: Karasahin
authors.forename: Firdevs
authors.initials: F
authors.lastname: Aktas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015780:Carbapenems / Q000494:pharmacology*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007709:Klebsiella / Q000187:drug effects* / Q000201:enzymology* / Q000302:isolation & purification; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems