JAC Advance Access published online on September 20, 2007
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkm356
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Risk factors of carbapenem-resistant Klebsiella pneumoniae infections: a matched case–control study
1 Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece 2 Department of Medicine, Tufts University School of Medicine, Boston, MA, USA 3 Department of Medicine, Henry Dunant Hospital, Athens, Greece 4 Department of Medicine, University Hospital of Heraklion, Heraklion, Greece 5 Intensive Care Unit, Henry Dunant Hospital, Athens, Greece 6 Department of Microbiology, Henry Dunant Hospital, Athens, Greece 7 Department of Microbiology, University Hospital of Heraklion, Heraklion, Greece
Received 7 June 2007; returned 27 July 2007; revised 17 August 2007; accepted 21 August 2007
* Correspondence address. Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23 Marousi, Greece. Tel: +30-694-611-0000; Fax: +30-210-683-9605; E-mail: m.falagas{at}aibs.gr
Background: Carbapenems are frequently used to treat infections due to extended-spectrum ß-lactamase-producing Klebsiella pneumoniae. Thus, the emergence of infections due to carbapenem-resistant K. pneumoniae (CRKp) is a major public health concern.
Objectives: To identify risk factors associated with the development of CRKp infections.
Methods: We conducted a matched case–control study in two hospitals (Henry Dunant Hospital, Athens, Greece and University Hospital of Heraklion, Crete, Greece). The controls were selected among patients with carbapenem-susceptible K. pneumoniae (CSKp) and were matched with CRKp cases for site of infection.
Results: One hundred and six patients were included in our study (53 cases and 53 controls). Mortality was 30.1% and 33.9% for patients with CRKp and CSKp infections, respectively (P = 0.83). Bivariable analysis showed that exposure to anti-pseudomonas penicillins (P = 0.004), carbapenems (P = 0.01), quinolones (P < 0.001) and glycopeptides (P < 0.001), as well as admission to the intensive care unit (P = 0.002), tracheostomy (P = 0.02), chronic obstructive pulmonary disease (P = 0.04), surgery with use of foreign body (P = 0.04) and mechanical ventilation (P = 0.02) were associated with CRKp infection. The multivariable analysis showed that exposure to fluoroquinolones [odds ratio (OR) 4.54, 95% confidence intervals (CIs) 1.78–11.54, P = 0.001] and exposure to antipseudomonal penicillins (OR 2.57, 95% CI 1.00–6.71, P = 0.04) were independent risk factors for CRKp infections.
Conclusions: Our data suggest that prior exposure to fluoroquinolones and antipseudomonal penicillins are independent risk factors for the development of CRKp infections.
Key Words: imipenem , meropenem , polymyxins , colistin , multidrug-resistant , mortality
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