title: Spectrum of excess mortality due to carbapenem-resistant Klebsiella pneumoniae infections.
abstract: Patients infected or colonized with carbapenem-resistant Klebsiella pneumoniae (CRKp) are often chronically and acutely ill, which results in substantial mortality unrelated to infection. Therefore, estimating excess mortality due to CRKp infections is challenging. The Consortium on Resistance against Carbapenems in K. pneumoniae (CRACKLE) is a prospective multicenter study. Here, patients in CRACKLE were evaluated at the time of their first CRKp bloodstream infection (BSI), pneumonia or urinary tract infection (UTI). A control cohort of patients with CRKp urinary colonization without CRKp infection was constructed. Excess hospital mortality was defined as mortality in cases after subtracting mortality in controls. In addition, the adjusted hazard ratios (aHR) for time-to-hospital-mortality at 30 days associated with infection compared with colonization were calculated in Cox proportional hazard models. In the study period, 260 patients with CRKp infections were included in the BSI (90 patients), pneumonia (49 patients) and UTI (121 patients) groups, who were compared with 223 controls. All-cause hospital mortality in controls was 12%. Excess hospital mortality was 27% in both patients with BSI and those with pneumonia. Excess hospital mortality was not observed in patients with UTI. In multivariable analyses, BSI and pneumonia compared with controls were associated with aHR of 2.59 (95% CI 1.52-4.50, p <0.001) and 3.44 (95% CI 1.80-6.48, p <0.001), respectively. In conclusion, in patients with CRKp infection, pneumonia is associated with the highest excess hospital mortality. Patients with BSI have slightly lower excess hospital mortality rates, whereas excess hospital mortality was not observed in hospitalized patients with UTI.
authors: Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA.
authors: C
authors: C
authors: Hauck
authors: Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA.
authors: E
authors: E
authors: Cober
authors: Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA.
authors: S S
authors: SS
authors: Richter
authors: Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA; Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors: F
authors: F
authors: Perez
authors: Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors: R A
authors: RA
authors: Salata
authors: Department of Medicine, MetroHealth Medical Center, Cleveland, OH, USA.
authors: R C
authors: RC
authors: Kalayjian
authors: Department of Internal Medicine, Northeast Ohio Medical University, Rootstown, OH, USA; Division of Infectious Diseases, Akron General Medical Center, Akron, OH, USA.
authors: R R
authors: RR
authors: Watkins
authors: Division of Infectious Diseases, Summa Health System, Akron, OH, USA.
authors: N M
authors: NM
authors: Scalera
authors: Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors: Y
authors: Y
authors: Doi
authors: Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, MI, USA.
authors: K S
authors: KS
authors: Kaye
authors: Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA, USA.
authors: S
authors: S
authors: Evans
authors: Division of Infectious Diseases, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA.
authors: V G
authors: VG
authors: Fowler
authors: Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA; Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors: R A
authors: RA
authors: Bonomo
authors: Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA. Electronic address: david_vanduin@med.unc.edu.
authors: D
authors: D
authors: van Duin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000382:microbiology / Q000401:mortality; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000382:microbiology* / Q000401:mortality*; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality; D018410:Pneumonia, Bacterial / Q000382:microbiology / Q000401:mortality; D011446:Prospective Studies; D016019:Survival Analysis; D014552:Urinary Tract Infections / Q000382:microbiology / Q000401:mortality; D018440:beta-Lactam Resistance
keywords: Klebsiella pneumoniae; carbapenem-resistant Enterobacteriaceae; epidemiology; mortality; pneumonia