1607. Associated Mortality Among Carbapenem-resistant Klebsiella pneumoniae cases in Los Angeles County Using Electronic Death Registry Data - 2010-2012
Session: Poster Abstract Session: Multidrug-Resistant Gram Negative Rods
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C

Background: CRKP is an emerging multidrug resistant pathogen and most frequently isolated species of carbapenem-resistant Enterobacteriaceae. In hospital specific studies, CRKP attributable mortality ranges from 44-50%. Two year laboratory-based surveillance of CRKP in Los Angeles County (LAC) gave insight to prevalence in the healthcare community; however mortality is unknown.

Methods: California Electronic Death Registry System (CA-EDRS) data for all deaths from June 2010-December 2012 was obtained from the California Department of Public Health. Data set included basic demographic information as well as location of death, 4 contributing causes of death (COD) and other significant conditions.  Cases in CRKP surveillance data, defined as a KP isolate with resistance to all carbapenems by CLSI criteria, were matched to CA-EDRS by first, last name and date of birth. COD variables for matches were searched for key words indicating infectious COD (bacteremia, pneumonia, urinary tract infection, decubitus ulcers). Mortality odds ratios (MOR) were calculated on CRKP specimen type and correlating infectious COD.

Results: Review yielded 862 matches among 1774 individuals in CRKP data set, resulting in 48.6% mortality among cases. Mean age was 75 years (range 22-101 years). The median length of time from diagnosis to death was 32 days (range 0-665 days). Half of deaths occurred in SNF residents. Cases with urine positive CRKP comprised a larger proportion of deaths (307, 36.2%). 468 cases (54%) had at least one infectious COD, the most frequently identified as pneumonia (304, 35%) and bacteremia (282, 33%).  Deaths in cases with positive wounds had higher odds of decubitus ulcers as a COD (MOR 5.6, 95% CI [2.5-13.8]), as well as sputum positive cases and pneumonia as COD (MOR 1.64, 95% CI [1.22-2.2]). CRKP was specifically identified as COD in four cases.

Conclusion: Infectious COD were identified nearly half of CRKP cases; there was an increased odds of decubitus ulcers as a contributing COD among wound positive cases than non-wound positive cases. If validated, review of electronic death record data may provide an estimate of mortality among CRKP positive individuals in the LAC healthcare community similar to that reported in the literature.

Patricia Marquez, MPH, Dawn Terashita, MD, MPH and Laurene Mascola, MD, MPH, Los Angeles County Department of Public Health, Los Angeles, CA


P. Marquez, None

D. Terashita, None

L. Mascola, None

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