title: Risk factors for carbapenem-resistant Klebsiella pneumoniae infection/colonization and predictors of mortality: a retrospective study.
abstract: OBJECTIVE
  To identify risk factors associated with carbapenem-resistant Klebsiella pneumoniae (CRKP) infection/colonization and death and to investigate the resistance and homology of CRKP.
  
  
  METHODS
  A retrospective 1:1 case-control study was conducted at Changhai Hospital, China, from January 2010 to December 2011.The study population included 30 patients with CRKP infection/colonization and 30 matched patients with carbapenem-susceptible K. pneumoniae (CSKP) infection/colonization at the same site. Homology analysis was conducted by multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE). Potential resistance genes were detected by PCR.
  
  
  RESULTS
  Independent risk factors for CRKP infection/colonization were admission to exposure to glycopeptides [Odds ratio (OR): 43.84, 95% confidence interval (CI): 1.73-1111.91, P = 0.020], cefoperazone plus sulbactam (OR: 49.56, 95% CI: 1.42-1726.72, P = 0.030) and tracheostomy (OR: 677.82, 95% CI: 2.76-1667, P = 0.020). Age (OR: 1.07, 95% CI: 1.00-1.14, P = 0.04), renal dysfunction (OR: 17.63, 95% CI: 2.34-132.87, P = 0.005) and exposure to cefoperazone plus sulbactam (OR: 8.87, 95% CI: 1.29-61.07, P = 0.026) were independent risk factors for the death of patients with K. pneumoniae infection/colonization. Older age (OR: 1.16, 95% CI: 1.01-1.39, P = 0.011) was an independent risk factor for the death of patients with CRKP infection/colonization. Thirty CRKP strains were all KPC-2-producing resistant strains with genotype of ST-11.
  
  
  CONCLUSIONS
  Exposure to glycopeptides, cefoperazone plus sulbactam and tracheostomy were independent risk factors for CRKP infection/colonization, and older age was an independent risk factor for CRKP infection/colonization caused death.
authors.forename: Yang
authors.initials: Y
authors.lastname: Jiao
authors.forename: Yanghua
authors.initials: Y
authors.lastname: Qin
authors.forename: Jiajun
authors.initials: J
authors.lastname: Liu
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.forename: Yuchao
authors.initials: Y
authors.lastname: Dong
authors.forename: Yan
authors.initials: Y
authors.lastname: Shang
authors.forename: Yi
authors.initials: Y
authors.lastname: Huang
authors.forename: Rui
authors.initials: R
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015780:Carbapenems / Q000627:therapeutic use*; D016022:Case-Control Studies; D002681:China / Q000453:epidemiology; D003428:Cross Infection / Q000517:prevention & control*; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000472:pathogenicity; D008297:Male; D008875:Middle Aged; D058885:Multilocus Sequence Typing / Q000379:methods*; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D014139:Tracheostomy / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems
keywords: Antimicrobial resistance; Carbapenem-resistant Klebsiella pneumoniae,; Mortality,; Risk factors,