389. Klebsiella pneumoniae resistant to carbapenem infection in a tertiary care teaching institution in Medellin Colombia
Session: Poster Abstract Session: Gram Negative Infection - Epidemiology and Prevention
Friday, October 21, 2011
Room: Poster Hall B1
Background: In 2008 the Hospital Pablo Tobón Uribe, a tertiary care hospital, the first in described the presence of KPC2 in Latin America, experienced an outbreak of Klebsiella pneumoniae resistant to carbapenems. The index case was a patient from the liver transplant program from Israel and Molecular biology studies confirmed the presence of KPC 3 producing K. pneumoniae  strain which was genetically indistinguishable from the Q strain from Israel.

Methods:Descriptive study of patients in whom KPC producing K. pneumonia infections were documented by clinical and microbiology, between 2007 and 2010.

Results: We analyzed data from 52 patients, the average age was 45.7 years +/- 27 years, 65.4% were men. The main comorbiditys were antecedent of gastrointestinal surgery 42%, immunosuppressive therapy 33%, chronic steroid use 31%, chronic liver disease 31% and solid organ transplantation 25%. All patients received antibiotics before the infection, the most common: aminoglycosides 27% and beta-lactams 25%.
During infection, 77% of patients were hospitalized in the intensive care unit. Microbiological diagnosis was confirmed in 90.4% of patients and the principal sites of isolation were blood 31% and abdominal cavity 23%. The antibiotic used were Colisitn in 40% and Tygecicline in 60%. The average duration of treatment was 15.76 +/- 7.5 days. . The main complications preseted by the patients during the infection were bacteremia (51.9%), acute renal failure (51.9%), multiorgan failure (38.5%) and disseminated intravascular coagulation (21.2%). In 19 patients was not possible to eradicate the germ despite the use of antibiotics.

Overall mortality was 48.1%. Mortality in patients with bacteremia was 74.1% versus 20% in patients without bacteremia (P = 0.01). With respect to the treatments used, mortality was 45% in infections treated with Tigecycline and 52% in infections treated with Colistin (P = 0.609).

Conclusion:  Our results show that comorbid conditions are important factors for infection by KPC producing  K. pneumoniae , including solid organ transplantation, immunosuppressive therapy, steroids and gastrointestinal surgery, who also required prior treatment with antibiotics, ICU, and the use of invasive medical devices.

Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Franco Montufar, MS, MSSc1, Miguel Mesa, MD1, Carlos Builes, MD1, Alicia Quiroga, MD1, Carolina Saldarriaga, MD1, Carolina Aguilar, MD1, John Zuleta, MD, MSSc2 and Ana Correa, MD, MSSc1, (1)Internal Medicine, Hospital Pablo Tobon Uribe, Medellin, Colombia, (2)Clinical Investigation Group , Hospital Pablo Tobon Uribe, Medellin, Colombia


F. Montufar, None

M. Mesa, None

C. Builes, None

A. Quiroga, None

C. Saldarriaga, None

C. Aguilar, None

J. Zuleta, None

A. Correa, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.