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Bloodstream Infections Caused by Metallo-β-Lactamase/Klebsiella pneumoniae Carbapenemase–Producing K. pneumoniae among Intensive Care Unit Patients in Greece: Risk Factors for Infection and Impact of Type of Resistance on Outcomes

Published online by Cambridge University Press:  02 January 2015

Eleni Mouloudi ,
Euthymia Protonotariou ,
Alexia Zagorianou ,
Elias Iosifidis ,
Areti Karapanagiotou ,
Tatiana Giasnetsova ,
Agoritsa Tsioka ,
Emmanuel Roilides ,
Danai Sofianou  and
Nikoleta Gritsi-Gerogianni
Eleni Mouloudi
Affiliation:
Intensive Care Unit, Thessaloniki, Greece
Euthymia Protonotariou
Affiliation:
Microbiology Department, and the Infection Control Department and the Third Department of Pediatrics, Aristotle University, Thessaloniki, Greece
Alexia Zagorianou
Affiliation:
Microbiology Department, and the Infection Control Department and the Third Department of Pediatrics, Aristotle University, Thessaloniki, Greece
Elias Iosifidis
Affiliation:
Hippokration General Hospital, Thessaloniki, Greece
Areti Karapanagiotou
Affiliation:
Intensive Care Unit, Thessaloniki, Greece
Tatiana Giasnetsova
Affiliation:
Intensive Care Unit, Thessaloniki, Greece
Agoritsa Tsioka
Affiliation:
Intensive Care Unit, Thessaloniki, Greece
Emmanuel Roilides*
Affiliation:
Hippokration General Hospital, Thessaloniki, Greece
Danai Sofianou
Affiliation:
Microbiology Department, and the Infection Control Department and the Third Department of Pediatrics, Aristotle University, Thessaloniki, Greece
Nikoleta Gritsi-Gerogianni
Affiliation:
Intensive Care Unit, Thessaloniki, Greece
*
Third Department of Pediatrics, Aristotle University, Hippokration Hospital, Konstantinoupoleos 49, GR-54642, Thessaloniki, Greece, (roilides@med.auth.gr)
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Abstract

Objective.

To determine risk factors for bloodstream infections (BSIs) caused by Klebsiella pneumoniae producing metallo-β-lactamases (MBLs) or K. pneumoniae carbapenemases (KPCs), as well as risk factors for mortality associated with carbapenem-resistant K. pneumoniae, among intensive care unit (ICU) patients.

Methods.

Two case-control studies were conducted in a patient cohort with K. pneumoniae BSIs in an 8-bed ICU in a Greek hospital from January 1, 2007, through December 31, 2008. In study 1, patients with K. pneumoniae BSIs were allocated among 3 groups according to isolate susceptibility profile: (1) carbapenem-susceptible insolates (control group), (2) MBL-producing isolates, or (3) KPC-producing isolates. The MBL and KPC groups were compared with the control group to identify risk factors for development of K. pneumoniae BSI. In study 2, patients with K. pneumoniae BSIs who died were compared with survivors to identify risk factors for mortality.

Results.

Fifty-nine patients had K. pneumoniae BSIs (22 with carbapenem-susceptible isolates, 18 with MBL-producing isolates, and 19 with KPC-producing isolates). All KPC-producing isolates carried the blaKPC-2 gene, and 17 of 18 MBL-producing isolates carried blaVIM-1 Acute Physiology and Chronic Health Evaluation II score (odds ratio, 1.13 [95% confidence interval, 1.03–1.25]; P = .02) was independently associated with KPC-producing K. pneumoniae BSIs. Nine (41%) of 22 control patients, 8 (44%) of 18 MBL group patients, and 13 (68%) of 19 KPC group patients died in the ICU. Nine (41%) of 22 control patients, 10 (56%) of 18 MBL group patients, and 15 (79%) of 19 KPC group patients died in the hospital. Isolation of KPC-producing K. pneumoniae was an independent predictor of ICU death (P = .04) and in-hospital death (P = .03) but not infection-attributable death.

Conclusions.

BSIs due to KPC-producing K. pneumoniae resulted in significantly increased mortality. The accurate and rapid detection of these pathogens is necessary for therapeutic considerations and for the implementation of infection control measures to contain them.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 12 , December 2010 , pp. 1250 - 1256
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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