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

  • Clinical and Epidemiological Study
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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.

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Authors and Affiliations

  1. Infectious Disease Unit, Shaare Zedek Medical Center, Jerusalem, Israel

    S. Shilo, T. Lachish, P. Kopuit, A. M. Yinnon & Y. Wiener-Well

  2. Clinical Microbiology Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel

    M. V. Assous

  3. Hebrew University–Hadassah Medical School, Jerusalem, Israel

    T. Bdolah-Abram

  4. Division of Internal Medicine, Shaare Zedek Medical Center, P.O. Box 3235, 91031, Jerusalem, Israel

    A. M. Yinnon

Authors
  1. S. Shilo
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  2. M. V. Assous
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  6. A. M. Yinnon
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Correspondence to A. M. Yinnon.

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Shilo, S., Assous, M.V., Lachish, T. et al. Risk factors for bacteriuria with carbapenem-resistant Klebsiella pneumoniae and its impact on mortality: a case–control study. Infection 41, 503–509 (2013). https://doi.org/10.1007/s15010-012-0380-0

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  • DOI: https://doi.org/10.1007/s15010-012-0380-0

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