1610. Risk for Readmissions in Hospitalized Patients with Carbapenem-Resistant Klebsiella pneumoniae
Session: Poster Abstract Session: Multidrug-Resistant Gram Negative Rods
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C

Background:

Carbapenem-resistant Klebsiella pneumoniae (CRKP) poses an increasing threat to hospitalized patients.

Methods:

The CRKP consortium prospectively studies CRKP in hospitalized patients in 18 medical centers (3 health care systems) in the Great Lakes region.  Here, we have focused on readmissions during which CRKP was again isolated.  Factors independently associated with readmission were examined with a multivariable logistic regression model.

Results:

In a 14 month study period, 250 unique patients were included.  Thirty-nine (16%) patients who did not survive their first admission were excluded. Of the remaining 211, 60 (28%) patients had a readmission with another CRKP positive culture, of whom 18 (30%) had more than one readmission.  Thirteen (22%) patients had readmission at a different hospital, but only 2 (3%) were readmitted to a hospital belonging to a different health care system.  Thirty five patients (58%) had CRKP isolated from the same source (usually urine, n=29) during all readmissions.  The characteristics of all first admissions are listed in the table.  The variables associated with risk for CRKP readmissions were home origin and Charlson comorbidity index.

Conclusion:

Over 1 in 4 hospitalized patients with cultures positive for CRKP are readmitted with recurrent CRKP positive cultures.  This illustrates the chronic nature of CRKP colonization, the contribution to CRKP colonization pressure, clinical morbidity and risk for continued transmission.  Home origin and comorbid illness were associated with higher risk of CRKP readmission.

 

Variable

No Readmit

Readmit

OR (95% CI)

p*

n

151

60

 

Age (median, IQR)

71 (59-81)

70 (55-82)

 

 

Charlson comorbidity index (median, IQR)

3 (2-5)

4 (2-7)

1.2 (1.1-1.4)*

0.002

Length of stay, days (median, IQR)

9 (5-14)

8 (6-18)

 

 

ICU stay

65 (43)

25 (42)

 

 

CRKP infection

78 (52)

34 (57)

 

 

Pitt≥4

45 (30)

19 (32)

 

 

Home origin

37 (24)

23 (38)

2.4 (1.2-4.7)

0.012

Home disposition

30 (20)

13 (22)

 

 

Table. Characteristics of first admission, comparing those patients who were subsequently readmitted with CRKP vs. all others. All data in n(%), unless otherwise stated. *per unit increase.

David Van Duin, MD, PhD1, Eric Cober, MD2, Federico Perez, MD3, Keith Kaye, MD, MPH, FIDSA, FSHEA4, Steven Gordon, MD, FIDSA, FSHEA2, Robert Kalayjian, MD5, Robert Salata, MD6, Robert A. Bonomo, MD7 and CRKP consortium, (1)Infectious Diseases, Medicine Institute and Transplant Center, Cleveland Clinic Foundation, Cleveland, OH, (2)Infectious Disease, Cleveland Clinic, Cleveland, OH, (3)University Hospitals Case Medical Center, Cleveland Heights, OH, (4)Infectious Diseases, Detroit Medical Center/ Wayne State University, Detroit, MI, (5)Infectious Diseases, The Metrohealth Medical Center, Cleveland, OH, (6)University Hospitals Case Medical Center, Cleveland, OH, (7)Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH

Disclosures:

D. Van Duin, None

E. Cober, None

F. Perez, None

K. Kaye, None

S. Gordon, None

R. Kalayjian, None

R. Salata, None

R. A. Bonomo, None

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