title: Predictive models for identification of hospitalized patients harboring KPC-producing Klebsiella pneumoniae.
abstract: The production of Klebsiella pneumoniae carbapenemases (KPCs) by Enterobacteriaceae has become a significant problem in recent years. To identify factors that could predict isolation of KPC-producing K. pneumoniae (KPCKP) in clinical samples from hospitalized patients, we conducted a retrospective, matched (1:2) case-control study in five large Italian hospitals. The case cohort consisted of adult inpatients whose hospital stay included at least one documented isolation of a KPCKP strain from a clinical specimen. For each case enrolled, we randomly selected two matched controls with no KPCKP-positive cultures of any type during their hospitalization. Matching involved hospital, ward, and month/year of admission, as well as time at risk for KPCKP isolation. A subgroup analysis was also carried out to identify risk factors specifically associated with true KPCKP infection. During the study period, KPCKP was isolated from clinical samples of 657 patients; 426 of these cases appeared to be true infections. Independent predictors of KPCKP isolation were recent admission to an intensive care unit (ICU), indwelling urinary catheter, central venous catheter (CVC), and/or surgical drain, ≥ 2 recent hospitalizations, hematological cancer, and recent fluoroquinolone and/or carbapenem therapy. A Charlson index of ≥ 3, indwelling CVC, recent surgery, neutropenia, ≥ 2 recent hospitalizations, and recent fluoroquinolone and/or carbapenem therapy were independent risk factors for KPCKP infection. Models developed to predict KPCKP isolation and KPCKP infection displayed good predictive power, with the areas under the receiver-operating characteristic curves of 0.82 (95% confidence interval [CI], 0.80 to 0.84) and 0.82 (95% CI, 0.80 to 0.85), respectively. This study provides novel information which might be useful for the clinical management of patients harboring KPCKP and for controlling the spread of this organism.
authors.affiliation: Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Rome, Italy tumbarello@rm.unicatt.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Tumbarello
authors.affiliation: Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Rome, Italy.
authors.forename: Enrico Maria
authors.initials: EM
authors.lastname: Trecarichi
authors.affiliation: Clinic of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Tumietto
authors.affiliation: Clinic of Infectious Diseases, University of Genoa (DISSAL) and IRCCS San Martino-IST, Genoa, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Del Bono
authors.affiliation: Department of Infectious Diseases, Amedeo di Savoia Hospital, University of Turin, Turin, Italy.
authors.forename: Francesco Giuseppe
authors.initials: FG
authors.lastname: De Rosa
authors.affiliation: Infectious Disease Division, Santa Maria Misericordia University Hospital, Udine, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bassetti
authors.affiliation: Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Rome, Italy.
authors.forename: Angela Raffaella
authors.initials: AR
authors.lastname: Losito
authors.affiliation: Clinic of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Tedeschi
authors.affiliation: Clinic of Infectious Diseases, University of Genoa (DISSAL) and IRCCS San Martino-IST, Genoa, Italy.
authors.forename: Carolina
authors.initials: C
authors.lastname: Saffioti
authors.affiliation: Department of Infectious Diseases, Amedeo di Savoia Hospital, University of Turin, Turin, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Corcione
authors.affiliation: Clinic of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Giannella
authors.affiliation: Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Raffaelli
authors.affiliation: Department of Infectious Diseases, Amedeo di Savoia Hospital, University of Turin, Turin, Italy.
authors.forename: Nicole
authors.initials: N
authors.lastname: Pagani
authors.affiliation: Clinic of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Bartoletti
authors.affiliation: Institute of Microbiology, Catholic University of the Sacred Heart, A. Gemelli Hospital, Rome, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Spanu
authors.affiliation: Section of Microbiology-DISC, University of Genoa, Genoa, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Marchese
authors.affiliation: Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cauda
authors.affiliation: Clinic of Infectious Diseases, University of Genoa (DISSAL) and IRCCS San Martino-IST, Genoa, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Viscoli
authors.affiliation: Clinic of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Viale
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001426:Bacterial Proteins / Q000378:metabolism*; D015780:Carbapenems / Q000627:therapeutic use; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D007558:Italy / Q000453:epidemiology; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000201:enzymology / Q000302:isolation & purification*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D024841:Fluoroquinolones; D001618:beta-Lactamases; C063912:carbapenemase
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