The production of Klebsiella pneumoniae (Kp) carbapenemases (KPCs) by Enterobacteriaceae has become a significant problem in recent years.To identify factors that could predict isolation of KPC-Kp in clinical samples from hospitalized patients, we conducted a retrospective, matched (1:2) case-control studies in five large Italian hospitals. The case cohort consisted of adult inpatients whose hospital stay included at least one documented isolation of a KPC-Kp strain from a clinical specimen. For each case enrolled, we randomly selected two matched controls with no KPC-Kp-positive cultures of any type during their hospitalization. Matching involved hospital, ward, and month/year of admission, as well as time at risk for KPC-Kp isolation. A subgroup analysis was also carried out to identify risk factors specifically associated with true KPC-Kp infection.During the study period, KPC-Kp was isolated from clinical samples of 657 patients; 426 of these cases appeared to be true infections. Independent predictors of KPC-Kp isolation were recent admission to ICU, indwelling urinary catheter, central venous catheter (CVC), and/or surgical drain, ≥ 2 recent hospitalizations, hematological cancer, and recent fluoroquinolone and/or carbapenem therapy. Charlson Index ≥3, indwelling CVC, recent surgery, neutropenia, ≥2 recent hospitalizations, and recent fluoroquinolone and/or carbapenem therapy were independent risk factors for KPC-Kp infection. Models developed to predict KPC-Kp isolation and KPC Kp infection displayed good predictive power with the areas under the receiver-operating characteristic curves of 0.82 (95% CI, 0.80-0.84) and 0.82 (95% CI, 0.80-0.85), respectively.This study provides novel information, which might be useful for the clinical management of patients harboring KPC Kp and for controlling the spread of these organisms.

Predictive Models for Identification of Hospitalized Patients Harboring KPC-Producing Klebsiella pneumoniae.

DE ROSA, Francesco Giuseppe;CORCIONE, Silvia;PAGANI, NICOLE;
2014

Abstract

The production of Klebsiella pneumoniae (Kp) carbapenemases (KPCs) by Enterobacteriaceae has become a significant problem in recent years.To identify factors that could predict isolation of KPC-Kp in clinical samples from hospitalized patients, we conducted a retrospective, matched (1:2) case-control studies in five large Italian hospitals. The case cohort consisted of adult inpatients whose hospital stay included at least one documented isolation of a KPC-Kp strain from a clinical specimen. For each case enrolled, we randomly selected two matched controls with no KPC-Kp-positive cultures of any type during their hospitalization. Matching involved hospital, ward, and month/year of admission, as well as time at risk for KPC-Kp isolation. A subgroup analysis was also carried out to identify risk factors specifically associated with true KPC-Kp infection.During the study period, KPC-Kp was isolated from clinical samples of 657 patients; 426 of these cases appeared to be true infections. Independent predictors of KPC-Kp isolation were recent admission to ICU, indwelling urinary catheter, central venous catheter (CVC), and/or surgical drain, ≥ 2 recent hospitalizations, hematological cancer, and recent fluoroquinolone and/or carbapenem therapy. Charlson Index ≥3, indwelling CVC, recent surgery, neutropenia, ≥2 recent hospitalizations, and recent fluoroquinolone and/or carbapenem therapy were independent risk factors for KPC-Kp infection. Models developed to predict KPC-Kp isolation and KPC Kp infection displayed good predictive power with the areas under the receiver-operating characteristic curves of 0.82 (95% CI, 0.80-0.84) and 0.82 (95% CI, 0.80-0.85), respectively.This study provides novel information, which might be useful for the clinical management of patients harboring KPC Kp and for controlling the spread of these organisms.
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Tumbarello M;Trecarichi EM;Tumietto F;Del Bono V;De Rosa FG;Bassetti M;Losito AR;Tedeschi S;Saffiotti C;Corcione S;Giannella M;Raffaelli F;Pagani N;Bartoletti M;Spanu T;Marchese A;Cauda R;Viscoli C;Viale P
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2318/1504825
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