Risk factors for bacteriuria with carbapenem-resistant Klebsiella pneumoniae and its impact on mortality: a case-control study.
Infection
; 41(2): 503-9, 2013 Apr.
Article
em En
| MEDLINE
| ID: mdl-23271210
ABSTRACT
BACKGROUND:
The objective of this study was to evaluate the mortality of and risk factors for bacteriuria due to carbapenem-resistant Klebsiella pneumoniae (CRKp) versus carbapenem-susceptible K. pneumoniae (CSKp) producing extended spectrum ß lactamase (ESBL).METHODS:
This was a retrospective case-control study in which 135 case-patients with bacteriuria due to CRKp were compared with 127 control patients with CSKp producing ESBL. In a first step, multivariate Cox regression and Kaplan-Meier survival analysis models were used to determine the difference in mortality between the two groups and risk factors for mortality. In a second step, a univariate analysis was used to identify risk factors for CRKp colonization.RESULTS:
There were no significant demographic or clinical differences between the groups. In-hospital mortality in the study and control groups was 29 and 25 %, respectively (non-significant difference). Multivariate analysis revealed that the most important risk factor for mortality in both groups was being bed ridden [hazard ratio 2.2, 95 % confidence interval (CI) 1.23-3.93; P = 0.008]. Patients with CRKp bacteriuria had a longer hospitalization time with a mean ± standard deviation of 28 ± 33 days compared to 22 ± 28 days in the control group (P < 0.05). Several univariate risk factors for acquiring CRKp bacteriuria were identified antibiotic use [odds ratio (OR) 1.93, 95 % CI 1.18-3.17, p = 0.008], especially colistin (OR 2.04, 95 % CI 1.04-4.02; P = 0.036), presence of a urinary catheter (OR 2.09, 95 % CI 1.2-3.63; P = 0.008), surgery (OR 3.94, 95 % CI 1.85-8.37; P = 0.0002), invasive procedures (OR 3.06, 95 % CI 1.61-5.8; P = 0.0004), and intensive care unit admission (OR 2.49, 95 % CI 1.18-5.37; P = 0.015).CONCLUSION:
Bacteriuria caused by CRKp as compared that caused by CSKp was not found to be a risk factor for death.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Bacteriúria
/
Infecções por Klebsiella
/
Carbapenêmicos
/
Resistência beta-Lactâmica
/
Klebsiella pneumoniae
Tipo de estudo:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adolescent
/
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Ano de publicação:
2013
Tipo de documento:
Article