Risk factors for bloodstream infections due to colistin-resistant KPC-producing Klebsiella pneumoniae: results from a multicenter case–control–control study

• DOI: 10.1016/j.cmi.2015.08.001
• Publication Date: 2015-08-14T05:02:30Z
• Authors: D.R. Giacobbe; V. Del Bono; E.M. Trecarichi; F.G. De Rosa; M. Giannella; M. Bassetti; A. Bartoloni; A.R. Losito; S. Corcione; M. Bartoletti; E. Mantengoli; C. Saffioti; N. Pagani; S. Tedeschi; T. Spanu; G.M. Rossolini; A. Marchese; S. Ambretti; R. Cauda; P. Viale; C. Viscoli; M. Tumbarello
• Keywords: Microbiology (medical); Male; 0301 basic medicine; Colistin resistance; Bacteremia; Bloodstream infection; 03 medical and health sciences; Risk Factors; Klebsiella; Drug Resistance, Multiple, Bacterial; risk factors; Humans; Aged; Colistin; Bloodstream infection; colistin resistance; Klebsiella; KPC; risk factors; Aged; Bacteremia; Case-Control Studies; Colistin; Drug Resistance, Multiple, Bacterial; Female; Hospitalization; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Middle Aged; Risk Factors; Microbiology (medical); Infectious Diseases; Middle Aged; Bloodstream infection; Colistin resistance; Klebsiella; KPC; Risk factors; Microbiology (medical); Infectious Diseases; Klebsiella Infections; 3. Good health; Hospitalization; KPC; Klebsiella pneumoniae; Infectious Diseases; colistin resistance; Case-Control Studies; Bloodstream infection; Colistin resistance; Klebsiella; KPC; Risk factors; Aged; Bacteremia; Case-Control Studies; Colistin; Drug Resistance, Multiple, Bacterial; Female; Hospitalization; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Middle Aged; Risk Factors; Female; Risk factor

The increasing prevalence of colistin resistance (ColR) Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (Kp) is a matter of concern because of its unfavourable impact on mortality of KPC-Kp bloodstream infections (BSI) and the shortage of alternative therapeutic options. A matched case-control-control analysis was conducted. The primary study end point was to assess risk factors for ColR KPC-Kp BSI. The secondary end point was to describe mortality and clinical characteristics of these infections. To assess risk factors for ColR, 142 patients with ColR KPC-Kp BSI were compared to two controls groups: 284 controls without infections caused by KPC-Kp (control group A) and 284 controls with colistin-susceptible (ColS) KPC-Kp BSI (control group B). In the first multivariate analysis (cases vs. group A), previous colistin therapy, previous KPC-Kp colonization, ≥3 previous hospitalizations, Charlson score ≥3 and neutropenia were found to be associated with the development of ColR KPC-Kp BSI. In the second multivariate analysis (cases vs. group B), only previous colistin therapy, previous KPC-Kp colonization and Charlson score ≥3 were associated with ColR. Overall, ColR among KPC-Kp blood isolates increased more than threefold during the 4.5-year study period, and 30-day mortality of ColR KPC-Kp BSI was as high as 51%. Strict rules for the use of colistin are mandatory to staunch the dissemination of ColR in KPC-Kp-endemic hospitals.