Infection

, Volume 41, Issue 2, pp 503–509

Risk factors for bacteriuria with carbapenem-resistant Klebsiella pneumoniae and its impact on mortality: a case–control study

  • S. Shilo
  • M. V. Assous
  • T. Lachish
  • P. Kopuit
  • T. Bdolah-Abram
  • A. M. Yinnon
  • Y. Wiener-Well
Clinical and Epidemiological Study

DOI: 10.1007/s15010-012-0380-0

Cite this article as:
Shilo, S., Assous, M.V., Lachish, T. et al. Infection (2013) 41: 503. doi:10.1007/s15010-012-0380-0

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 β 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.

Keywords

Carbapenem resistanceKlebsiella pneumoniaeMulti-drug resistanceBacteriuriaUrinary tract infectionNosocomial infection

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • S. Shilo
    • 1
  • M. V. Assous
    • 2
  • T. Lachish
    • 1
  • P. Kopuit
    • 1
  • T. Bdolah-Abram
    • 3
  • A. M. Yinnon
    • 1
    • 4
  • Y. Wiener-Well
    • 1
  1. 1.Infectious Disease UnitShaare Zedek Medical CenterJerusalemIsrael
  2. 2.Clinical Microbiology LaboratoryShaare Zedek Medical CenterJerusalemIsrael
  3. 3.Hebrew University–Hadassah Medical SchoolJerusalemIsrael
  4. 4.Division of Internal MedicineShaare Zedek Medical CenterJerusalemIsrael