Risk factors for the first episode of Klebsiella pneumoniae resistant to carbapenems infection in critically ill patients: a prospective study.
OBJECTIVE
To identify risk factors for the first episode of Klebsiella Pneumonia resistant to carbapenems (KPRC) infection in critically ill patients.


METHODS
This prospective cohort study was conducted in a 12-bed general Intensive Care Unit (ICU) in a University Hospital on ICU patients who required mechanical ventilation (MV) for >48 hours during a 12-month period. Clinical and microbiologic data were studied. Characteristics of KPRC patients were compared with those of critically ill patients who presented nonmultidrug resistant (MDR) bacterial infections or no documented infection at all.


RESULTS
Twenty-five patients presented KPRC infection, 18 presented non-MDR bacterial infection, and 39 patients presented no infection. Compared to patients without documented infection or infected by non MDR bacteria, patients with KPRC infection had received more frequently or for longer duration antibiotics against Gram-negative bacteria (carbapenems, colistin P < 0.05). Duration of colistin administration prior to KPRC isolation was independently associated with increased frequency of KPRC infection (odds ratio, 1.156 per day; 95% confidence interval, 1.010 to 1.312; P = 0.025). KPRC patients stayed longer in the ICU and received mechanical ventilation and sedation for longer periods and presented increased mortality (P < 0.05).


CONCLUSIONS
KPRC infection is an emerging problem which might be more common in patients with previous use of antibiotics and especially colistin.
Department of Critical Care, School of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Thessaly, Greece.
Konstantinos
K
Mantzarlis
Department of Critical Care, School of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Thessaly, Greece.
Demosthenes
D
Makris
Department of Critical Care, School of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Thessaly, Greece.
Efstratios
E
Manoulakas
Department of Critical Care, School of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Thessaly, Greece.
Marios
M
Karvouniaris
Department of Critical Care, School of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Thessaly, Greece.
Epaminondas
E
Zakynthinos
D000328:Adult; D000368:Aged; D015780:Carbapenems / Q000008:administration & dosage*; D003091:Colistin / Q000008:administration & dosage; D016638:Critical Illness; D004352:Drug Resistance, Microbial / Q000235:genetics; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000235:genetics / Q000472:pathogenicity; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy* / Q000235:genetics / Q000382:microbiology* / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors
D015780:Carbapenems; D003091:Colistin