title: Risk factors for infection with carbapenem-resistant Klebsiella pneumoniae: a case-case-control study.
abstract: OBJECTIVE
  To evaluate the association between quinolone exposure and the emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) and to estimate CRKP-specific mortality.
  
  
  METHODS
  Case-case-control study implemented in a tertiary care institution. Three groups of patients were analyzed: 61 consecutive cases of infection with CRKP (Group I); 61 randomly chosen cases of patients infected with carbapenem-sensitive Klebsiella pneumoniae (CSKP; Group II); and 122 randomly chosen controls without CRKP or CSKP infection. Matching was based on the length of stay in intensive care unit and the date of bacterial isolation. An active search was performed for patients with CRKP and CSKP infection, and prospective cases were included in the study. We compared the results for Groups I and II against those for the controls by using two conditional logistic regression analyses that included infection as the dependent variable and controlled for time at risk and comorbidities.
  
  
  RESULTS
  Exposure to quinolones was not associated with CRKP infection: no association was found in the analysis of CRKP with the controls (OR=1.7; 95% CI: 0.2-6.5) or in the analysis of CSKP against the controls (OR=0.6; 95% CI: 0.2-1.6). Use of carbapenems (OR=3.3; 95% CI: 1.2-9.3) and colonization with CRKP (OR=3.3; 95% IC: 1.2-9.3) were specific risk factors for infection with CRKP. Mortality associated with CRKP was 61.3%.
  
  
  CONCLUSIONS
  No association was found between exposure to quinolones and infection with CRKP; however, colonization by CRKP and use of carbapenems are risk factors for infection with CRKP.
authors.affiliation: Clinical Epidemiology Group, Universidad de Antioquia, Medellín, Antioquia, Colombia.
authors.forename: Viviana
authors.initials: V
authors.lastname: Gómez Rueda
authors.affiliation: Clinical Epidemiology Group, Universidad de Antioquia, Medellín, Antioquia, Colombia.
authors.forename: John Jairo
authors.initials: JJ
authors.lastname: Zuleta Tobón
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015780:Carbapenems / Q000494:pharmacology*; D016022:Case-Control Studies; D002648:Child; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000302:isolation & purification*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015363:Quinolones / Q000494:pharmacology; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D015363:Quinolones
keywords: Klebsiella pneumoniae; carbapenems; case-control studies; quinolones; risk factors
references.citation: Infect Control Hosp Epidemiol. 2009 Jul;30(7):666-71
references.pmid: 19496647
references.citation: Lancet Infect Dis. 2009 Apr;9(4):228-36
references.pmid: 19324295
references.citation: Clin Infect Dis. 1998 Aug;27 Suppl 1:S5-11
references.pmid: 9710666
references.citation: Infect Control Hosp Epidemiol. 2010 May;31(5):476-84
references.pmid: 20334553
references.citation: J Antimicrob Chemother. 2011 Jun;66(6):1383-91
references.pmid: 21454344
references.citation: Antimicrob Agents Chemother. 2008 Mar;52(3):1028-33
references.pmid: 18086836
references.citation: Infect Control Hosp Epidemiol. 2010 Dec;31(12):1250-6
references.pmid: 20973725
references.citation: Clin Infect Dis. 2002 Jun 15;34(12):1564-7
references.pmid: 12032890
references.citation: South Med J. 2011 Feb;104(2):106-10
references.pmid: 21258230
references.citation: Infect Control Hosp Epidemiol. 2005 Apr;26(4):338-41
references.pmid: 15865267
references.citation: Infect Control Hosp Epidemiol. 2008 Oct;29(10):966-8
references.pmid: 18754738
references.citation: Infect Control Hosp Epidemiol. 2009 Oct;30(10):972-6
references.pmid: 19712030
references.citation: Clin Infect Dis. 2002 Jun 15;34(12):1558-63
references.pmid: 12032889
references.citation: Am J Infect Control. 2012 Jun;40(5):421-5
references.pmid: 21906844
references.citation: Microb Drug Resist. 2010 Dec;16(4):303-8
references.pmid: 20528101
references.citation: J Hosp Infect. 2004 Jul;57(3):209-16
references.pmid: 15236849
references.citation: J Chronic Dis. 1987;40(5):373-83
references.pmid: 3558716
references.citation: Infect Control Hosp Epidemiol. 2005 Apr;26(4):346-51
references.pmid: 15865269
references.citation: Infect Control Hosp Epidemiol. 2000 Nov;21(11):718-23
references.pmid: 11089656
references.citation: Infect Control Hosp Epidemiol. 2008 Dec;29(12):1099-106
references.pmid: 18973455
references.citation: Clin Infect Dis. 2001 Apr 1;32(7):1055-61
references.pmid: 11264034
references.citation: Microb Drug Resist. 2005 Summer;11(2):165-9
references.pmid: 15910232
references.citation: Antimicrob Agents Chemother. 2006 Aug;50(8):2880-2
references.pmid: 16870793
references.citation: Infect Control Hosp Epidemiol. 2009 Dec;30(12):1180-5
references.pmid: 19860564
references.citation: Clin Infect Dis. 2002 Feb 1;34(3):340-5
references.pmid: 11774081