1404. Risk Factors for Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infections: A Case-Control Study
Session: Poster Abstract Session: Epidemiology of Multiple Drug-Resistant Gram Negative Rods
Saturday, October 20, 2012
Room: SDCC Poster Hall F-H
  • PGY2 IDSA Poster Temple SAN DIEGO.pdf (322.4 kB)
  • Background: Carbapenem resistant (CR) Klebsiella pneumoniae (KP) are an emerging medical concern. Reported risk factors for infection with CR KP include higher severity of illness, increased length of stay, and intensive care unit (ICU) stay.  Some evidence indicates that cumulative antibiotic exposure may be more important to the development of CR Enterobacteriaceae infection than the use of any specific antibiotic class.

    Methods: A case-control study was conducted of patients at Temple University Hospital during 6/2005 – 10/2010.  Case group inclusion criteria included a positive blood culture for CR KP, first episode of CR KP bacteremia, and age ≥ 18 years. Exclusion criteria included lack of clinical evidence of infection and hospitalization ≤ 72 hours. Controls were matched to cases by date and hospital unit. Collected patient information included: nursing home residency, recent hospitalizations, antibiotic history and duration, length of stay, Charlson Comorbidity Index, APACHE II score, ICU admission, mechanical ventilation, dialysis, catheterization, and antibiotic therapy and duration. The primary objective was to determine independent risk factors for developing CR KP bacteremia. The secondary objective was to determine specific antibiotic classes associated with infection. Univariate and multivariate analyses were used to analyze the data. 

    Results: 44 case patients were identified and matched accordingly. Antibiotics associated with CR KP bacteremia included cephalosporins, penicillins, carbapenems, fluoroquinolones, metronidazole, and vancomycin, but none were significant on multivariate analysis. Independent risk factors for KPC producing KP bacteremia included the number of antibiotics used in the past 90 days (OR 3.92 [CI 1.60-9.67]), increased length of stay (OR 1.07 [1.03-1.12]), and mechanical ventilation (OR 6.64 [CI 1.16-38.12]).  45% of cases died, as compared to 18% of controls [OR 3.8 (CI 1.4-9.9)]. 

    Conclusion: Risk factors identified in this study were similar to those reported in the literature.  Overall antibiotic exposure was a stronger predictor of CR KP bacteremia than any individual drug class. The findings support the importance of antibiotic stewardship to limit drug resistance.

    Safia Kuriakose, PharmD, Pharmacy, Temple University Hospital, Philadelphia, PA and Jason Gallagher, Pharm.D., B.C.P.S., Temple University, Philadelphia, PA


    S. Kuriakose, None

    J. Gallagher, Merck: Grant Investigator, Grant recipient

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