Risk factors for bloodstream infections due to colistin-resistant KPC-producing Klebsiella pneumoniae: results from a multicenter case-control-control study.
The increasing prevalence of colistin resistance (ColR) Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (Kp) is a matter of concern because of its unfavourable impact on mortality of KPC-Kp bloodstream infections (BSI) and the shortage of alternative therapeutic options. A matched case-control-control analysis was conducted. The primary study end point was to assess risk factors for ColR KPC-Kp BSI. The secondary end point was to describe mortality and clinical characteristics of these infections. To assess risk factors for ColR, 142 patients with ColR KPC-Kp BSI were compared to two controls groups: 284 controls without infections caused by KPC-Kp (control group A) and 284 controls with colistin-susceptible (ColS) KPC-Kp BSI (control group B). In the first multivariate analysis (cases vs. group A), previous colistin therapy, previous KPC-Kp colonization, ≥3 previous hospitalizations, Charlson score ≥3 and neutropenia were found to be associated with the development of ColR KPC-Kp BSI. In the second multivariate analysis (cases vs. group B), only previous colistin therapy, previous KPC-Kp colonization and Charlson score ≥3 were associated with ColR. Overall, ColR among KPC-Kp blood isolates increased more than threefold during the 4.5-year study period, and 30-day mortality of ColR KPC-Kp BSI was as high as 51%. Strict rules for the use of colistin are mandatory to staunch the dissemination of ColR in KPC-Kp-endemic hospitals.
Infectious Diseases Division, University of Genoa (DISSAL) and IRCCS San Martino-IST, Genoa, Italy.
D R
DR
Giacobbe
Infectious Diseases Division, University of Genoa (DISSAL) and IRCCS San Martino-IST, Genoa, Italy.
V
V
Del Bono
Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Rome, Italy.
E M
EM
Trecarichi
Department of Infectious Diseases, Amedeo di Savoia Hospital, University of Turin, Turin, Italy.
F G
FG
De Rosa
Clinic of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
M
M
Giannella
Infectious Disease Division, Santa Maria Misericordia University Hospital, Udine, Italy.
M
M
Bassetti
Infectious and Tropical Diseases Unit, Careggi Hospital, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
A
A
Bartoloni
Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Rome, Italy.
A R
AR
Losito
Department of Infectious Diseases, Amedeo di Savoia Hospital, University of Turin, Turin, Italy.
S
S
Corcione
Clinic of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
M
M
Bartoletti
Infectious and Tropical Diseases Unit, Careggi Hospital, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
E
E
Mantengoli
Infectious Diseases Division, University of Genoa (DISSAL) and IRCCS San Martino-IST, Genoa, Italy.
C
C
Saffioti
Department of Infectious Diseases, Amedeo di Savoia Hospital, University of Turin, Turin, Italy.
N
N
Pagani
Clinic of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
S
S
Tedeschi
Institute of Microbiology, Catholic University of the Sacred Heart, A. Gemelli Hospital, Rome, Italy.
T
T
Spanu
Department of Medical Biotechnologies, University of Siena, Siena, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy.
G M
GM
Rossolini
Section of Microbiology-DISC, University of Genoa and IRCCS San Martino- IST, Genoa, Italy.
A
A
Marchese
Unit of Clinical Microbiology, S. Orsola-Malpighi University Hospital, Bologna, Italy.
S
S
Ambretti
Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Rome, Italy.
R
R
Cauda
Clinic of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
P
P
Viale
Infectious Diseases Division, University of Genoa (DISSAL) and IRCCS San Martino-IST, Genoa, Italy.
C
C
Viscoli
Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Rome, Italy. Electronic address: tumbarello@rm.unicatt.it.
M
M
Tumbarello
D000368:Aged; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D016022:Case-Control Studies; D003091:Colistin / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000145:classification* / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
D003091:Colistin
Bloodstream infection; KPC; Klebsiella; colistin resistance; risk factors