Clinical and Epidemiological Study

Infection

, Volume 41, Issue 2, pp 503-509

First online:

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

  • S. ShiloAffiliated withInfectious Disease Unit, Shaare Zedek Medical Center
  • , M. V. AssousAffiliated withClinical Microbiology Laboratory, Shaare Zedek Medical Center
  • , T. LachishAffiliated withInfectious Disease Unit, Shaare Zedek Medical Center
  • , P. KopuitAffiliated withInfectious Disease Unit, Shaare Zedek Medical Center
  • , T. Bdolah-AbramAffiliated withHebrew University–Hadassah Medical School
  • , A. M. YinnonAffiliated withInfectious Disease Unit, Shaare Zedek Medical CenterDivision of Internal Medicine, Shaare Zedek Medical Center Email author 
  • , Y. Wiener-WellAffiliated withInfectious Disease Unit, Shaare Zedek Medical Center

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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 resistance Klebsiella pneumoniae Multi-drug resistance Bacteriuria Urinary tract infection Nosocomial infection