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Risk Factors and Clinical Impact of Klebsiella pneumoniae Carbapenemase–Producing K. pneumoniae
Leanne B. Gasink , MD, MSCE, Paul H. Edelstein , MD, Ebbing Lautenbach , MD, MPH, MSCE, Marie Synnestvedt , PhD and Neil O. Fishman , MD
Infection Control and Hospital Epidemiology
Vol. 30, No. 12 (December 2009), pp. 1180-1185
Published by: Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America
Stable URL: http://www.jstor.org/stable/10.1086/648451
Page Count: 6
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Background. Klebsiella pneumoniae carbapenemase (KPC)–producing K. pneumoniae is an emerging pathogen with serious clinical and infection control implications. To our knowledge, no study has specifically examined risk factors for KPC‐producing K. pneumoniae or its impact on mortality. Methods. To identify risk factors for infection or colonization with KPC‐producing K. pneumoniae, a case‐control study was performed. Case patients with KPC‐producing K. pneumoniae were compared with control subjects with carbapenem‐susceptible K. pneumoniae. A cohort study evaluated the association between KPC‐producing K. pneumoniae and in‐hospital mortality. Results. Fifty‐six case patients and 863 control subjects were identified. In multivariable analysis, independent risk factors for KPC‐producing K. pneumoniae were (1) severe illness (adjusted odds ratio [AOR], 4.31; 95% confidence interval [CI], 2.25–8.25), (2) prior fluoroquinolone use (AOR, 3.39; 95% CI, 1.50, 7.66), and (3) prior extended‐spectrum cephalosporin use (AOR, 2.55; 95% CI, 1.18, 5.52). Compared with samples from other anatomic locations, K. pneumoniae isolates from blood samples were less likely to harbor KPC (AOR, 0.33; 95% CI, 0.12, 0.86). KPC‐producing K. pneumoniae was independently associated with in‐hospital mortality (AOR, 3.60; 95% CI, 1.87–6.91). Conclusions. KPC‐producing K. pneumoniae is an emerging pathogen associated with significant mortality. Our findings highlight the urgent need to develop strategies for prevention and infection control. Limiting use of certain antimicrobials, specifically fluoroquinolones and cephalosporins, use may be effective strategies.
© 2009 by The Society for Healthcare Epidemiology of America. All rights reserved.