title: Mortality due to blaKPC Klebsiella pneumoniae bacteraemia.
abstract: OBJECTIVE
  To determine the mortality rate secondary to blaKPC Klebsiella pneumoniae (KPC/Kp) bacteraemia, compared with that from ESBL-producing K. pneumoniae (ESBL/Kp) bacteraemia, and to determine associated risk factors.
  
  
  METHODS
  This was a retrospective case-control study of all 68 KPC/Kp bacteraemia patients diagnosed since 2006, matched by year of isolation, gender and age, at a ratio of 1:2, to 136 ESBL/Kp bacteraemia patients.
  
  
  RESULTS
  There were no demographic differences between the two groups, but there were minor clinical differences. Fewer KPC/Kp study patients than ESBL/Kp control patients had a systolic blood pressure <90 mmHg (32/68, 47% versus 86/136, 63%, respectively, P = 0.02) or urinary catheterization (32/68, 47% versus 90/136, 66%, respectively, P = 0.005), while the KPC/Kp bacteraemia group had a greater incidence of acute renal failure (45/68, 66% versus 67/136, 49%, respectively, P = 0.02). There was no difference between the two groups in duration of hospitalization. The mortality rate of the KPC/Kp bacteraemia group was 44/68 (65%) compared with 54/136 (40%) in the ESBL/Kp bacteraemia control group (P = 0.008), which in the multivariate analysis remained highly significant (P < 0.001). Only 11/68 (16%) of KPC/Kp patients were functionally independent at discharge compared with 43/136 (32%) ESBL/Kp patients (P = 0.012).
  
  
  CONCLUSIONS
  The selection of an ESBL/Kp control cohort with a ratio of 1:2 (study versus control group) helped resolve an as yet insufficiently settled question: bacteraemia with KPC/Kp is an independent risk factor for death, justifying the strict adherence to cohorting and isolation procedures.
authors.affiliation: Division of Internal Medicine, Shaare-Zedek Medical Center, Jerusalem, Israel, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel Infectious Disease Unit, Shaare-Zedek Medical Center, Jerusalem, Israel, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel.
authors.forename: Yedidah
authors.initials: Y
authors.lastname: Fraenkel-Wandel
authors.affiliation: Infectious Disease Unit, Shaare-Zedek Medical Center, Jerusalem, Israel, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Raveh-Brawer
authors.affiliation: Infectious Disease Unit, Shaare-Zedek Medical Center, Jerusalem, Israel, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel.
authors.forename: Yonit
authors.initials: Y
authors.lastname: Wiener-Well
authors.affiliation: Division of Internal Medicine, Shaare-Zedek Medical Center, Jerusalem, Israel, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel Infectious Disease Unit, Shaare-Zedek Medical Center, Jerusalem, Israel, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel yinnon@szmc.org.il.
authors.forename: Amos M
authors.initials: AM
authors.lastname: Yinnon
authors.affiliation: Microbiology Laboratory, Shaare-Zedek Medical Center, Jerusalem, Israel, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel.
authors.forename: Marc V
authors.initials: MV
authors.lastname: Assous
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D016470:Bacteremia; D016022:Case-Control Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality*; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000096:biosynthesis* / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases