title: Hospital Readmissions in Patients With Carbapenem-Resistant Klebsiella pneumoniae.
abstract: BACKGROUND
  Various transmission routes contribute to spread of carbapenem-resistant Klebsiella pneumoniae (CRKP) in hospitalized patients. Patients with readmissions during which CRKP is again isolated ("CRKP readmission") potentially contribute to transmission of CRKP.
  
  
  OBJECTIVE
  To evaluate CRKP readmissions in the Consortium on Resistance against Carbapenems in K. pneumoniae (CRaCKLe).
  
  
  METHODS
  Cohort study from December 24, 2011, through July 1, 2013.
  
  
  METHODS
  Multicenter consortium of acute care hospitals in the Great Lakes region.
  
  
  METHODS
  All patients who were discharged alive during the study period were included. Each patient was included only once at the time of the first CRKP-positive culture.
  
  
  METHODS
  All readmissions within 90 days of discharge from the index hospitalization during which CRKP was again found were analyzed. Risk factors for CRKP readmission were evaluated in multivariable models.
  
  
  RESULTS
  Fifty-six (20%) of 287 patients who were discharged alive had a CRKP readmission. History of malignancy was associated with CRKP readmission (adjusted odds ratio [adjusted OR], 3.00 [95% CI, 1.32-6.65], P<.01). During the index hospitalization, 160 patients (56%) received antibiotic treatment against CRKP; the choice of regimen was associated with CRKP readmission (P=.02). Receipt of tigecycline-based therapy (adjusted OR, 5.13 [95% CI, 1.72-17.44], using aminoglycoside-based therapy as a reference in those treated with anti-CRKP antibiotics) was associated with CRKP readmission.
  
  
  CONCLUSIONS
  Hospitalized patients with CRKP-specifically those with a history of malignancy-are at high risk of readmission with recurrent CRKP infection or colonization. Treatment during the index hospitalization with a tigecycline-based regimen increases this risk.
authors.affiliation: 1Division of Infectious Diseases,Duke University,Durham,North Carolina.
authors.forename: Julia A
authors.initials: JA
authors.lastname: Messina
authors.affiliation: 3Department of Infectious Diseases,Cleveland Clinic,Cleveland,Ohio.
authors.forename: Eric
authors.initials: E
authors.lastname: Cober
authors.affiliation: 4Department of Laboratory Medicine,Cleveland Clinic,Cleveland,Ohio.
authors.forename: Sandra S
authors.initials: SS
authors.lastname: Richter
authors.affiliation: 5Research Service,Louis Stokes Veterans Affairs Medical Center,Cleveland,Ohio.
authors.forename: Federico
authors.initials: F
authors.lastname: Perez
authors.affiliation: 6Division 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 Medicine,MetroHealth Medical Center,Cleveland,Ohio.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Kalayjian
authors.affiliation: 8Department of Internal Medicine,Northeast Ohio Medical University,Rootstown,Ohio.
authors.forename: Richard R
authors.initials: RR
authors.lastname: Watkins
authors.affiliation: 10Division of Infectious Diseases,Summa Health System,Akron,Ohio.
authors.forename: Nikole M
authors.initials: NM
authors.lastname: Scalera
authors.affiliation: 11Division of Infectious Diseases,University of Pittsburgh School of Medicine,Pittsburgh,Pennsylvania.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Doi
authors.affiliation: 12Division of Infectious Diseases,Detroit Medical Center,Wayne State University,Detroit,Michigan.
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
authors.affiliation: 13Department 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: 5Research Service,Louis Stokes Veterans Affairs Medical Center,Cleveland,Ohio.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Bonomo
authors.affiliation: 1Division of Infectious Diseases,Duke University,Durham,North Carolina.
authors.forename: Vance G
authors.initials: VG
authors.lastname: Fowler
authors.affiliation: 16Division of Infectious Diseases,University of North Carolina,Chapel Hill,North Carolina.
authors.forename: David
authors.initials: D
authors.lastname: van Duin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D003428:Cross Infection / Q000188:drug therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007710:Klebsiella Infections / Q000188:drug therapy*; D007711:Klebsiella pneumoniae / Q000187:drug effects; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D008911:Minocycline / Q000031:analogs & derivatives / Q000627:therapeutic use; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D000078304:Tigecycline; D014481:United States; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D000078304:Tigecycline; D008911:Minocycline