title: Residence in Skilled Nursing Facilities Is Associated with Tigecycline Nonsusceptibility in Carbapenem-Resistant Klebsiella pneumoniae.
abstract: OBJECTIVE
  To determine the rates of and risk factors for tigecycline nonsusceptibility among carbapenem-resistant Klebsiella pneumoniae (CRKPs) isolated from hospitalized patients.
  
  
  METHODS
  Multicenter prospective observational study.
  
  
  METHODS
  Acute care hospitals participating in the Consortium on Resistance against Carbapenems in Klebsiella pneumoniae (CRaCKle).
  
  
  METHODS
  A cohort of 287 patients who had CRKPs isolated from clinical cultures during hospitalization.
  
  
  METHODS
  For the period from December 24, 2011 to October 1, 2013, the first hospitalization of each patient with a CRKP during which tigecycline susceptibility for the CRKP isolate was determined was included. Clinical data were entered into a centralized database, including data regarding pre-hospital origin. Breakpoints established by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) were used to interpret tigecycline susceptibility testing.
  
  
  RESULTS
  Of 287 patients included in the final cohort, 155 (54%) had tigecycline-susceptible CRKPs. Of all index isolates, 81 (28%) were tigecycline-intermediate and 51 (18%) were tigecycline resistant. In multivariate modeling, independent risk factors for tigecycline nonsusceptibility were (1) admission from a skilled nursing facility (OR, 2.51; 95% CI, 1.51-4.21; P=.0004), (2) positive culture within 2 days of admission (OR, 1.82; 95% CI, 1.06-3.15; P=.03), and (3) receipt of tigecycline within 14 days (OR, 4.38, 95% CI, 1.37-17.01, P=.02).
  
  
  CONCLUSIONS
  In hospitalized patients with CRKPs, tigecycline nonsusceptibility was more frequently observed in those admitted from skilled nursing facilities and occurred earlier during hospitalization. Skilled nursing facilities are an important target for interventions to decrease antibacterial resistance to antibiotics of last resort for treatment of CRKPs.
authors.affiliation: 1Division of Infectious Diseases,University of North Carolina,Chapel Hill,North Carolina.
authors.forename: David
authors.initials: D
authors.lastname: van Duin
authors.affiliation: 2Department of Infectious Diseases,Cleveland Clinic,Cleveland,Ohio.
authors.forename: Eric
authors.initials: E
authors.lastname: Cober
authors.affiliation: 3Department of Laboratory Medicine,Cleveland Clinic,Cleveland,Ohio.
authors.forename: Sandra S
authors.initials: SS
authors.lastname: Richter
authors.affiliation: 4Research Service,Louis Stokes Cleveland Department of Veterans Affairs Medical Center,Cleveland,Ohio.
authors.forename: Federico
authors.initials: F
authors.lastname: Perez
authors.affiliation: 6Department of Medicine,MetroHealth Medical Center,Cleveland,Ohio.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Kalayjian
authors.affiliation: 5Division of Infectious Diseases and HIV Medicine,Department of Medicine,Case Western Reserve University School of Medicine,Cleveland,Ohio.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Salata
authors.affiliation: 7Department of Biostatistics and the Center for Biostatistics in AIDS Research,Harvard School of Public Health,Boston,Massachusetts.
authors.forename: Scott
authors.initials: S
authors.lastname: Evans
authors.affiliation: 8Division of Infectious Diseases,Duke University,Durham,North Carolina.
authors.forename: Vance G
authors.initials: VG
authors.lastname: Fowler
authors.affiliation: 4Research Service,Louis Stokes Cleveland Department of Veterans Affairs Medical Center,Cleveland,Ohio.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Bonomo
authors.affiliation: 11Division of Infectious Diseases,Detroit Medical Center,Wayne State University,Detroit,Michigan.
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D015780:Carbapenems / Q000494:pharmacology; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D008911:Minocycline / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D011446:Prospective Studies; D012307:Risk Factors; D012866:Skilled Nursing Facilities; D000078304:Tigecycline; D013997:Time Factors; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D000078304:Tigecycline; D008911:Minocycline