Community Origin and Mortality in Pneumonia Caused by Carbapenem-Resistant Klebsiella pneumoniae
Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an increasingly important cause of pneumonia. In order to understand the factors that impact outcomes of CRKP pneumonia, we examined a nested cohort of patients that are enrolled in the prospective Consortium on Resistance against Carbapenems in K. pneumoniae (CRaCKle).
Methods: CRaCKle is a prospective multicenter consortium which includes 21 hospitals serving more than 2 million people in the Great Lakes region. All hospitalized patients with CRKP pneumonia were included if their hospitalization began and ended within the study period from 12/24/2011 until 10/1/2013. Each patient was only included once at the time of their first respiratory culture from which CRKP was isolated. Criteria outlined by the American Thoracic Society and the Infectious Diseases Society of America were used to define pneumonia. Severe acute illness was defined as a Pitt bacteremia score ≥4.
Results: 29 unique patients with CRKP pneumonia were included; median age was 71 years (IQR 57.5-80 years), median Charlson score was 3 (IQR 2-5), 18 (62%) were female, 16 (55%) were Caucasian, 13 (45%) had chronic obstructive pulmonary disease (COPD), 2 (7%) had bacteremia. 25 (86%) patients were on mechanical ventilation at the time of culture. Eight (28%) patients were admitted from home. Most patients were admitted from long term chronic care (12/29, 41%) or long term acute care (4/29, 14%), 5 (17%) patients were transferred from other hospitals; Median time from admission to first positive culture was 9 days (IQR 6-38 days) in patients admitted from home, vs. 7 days (IQR 1-15 days) in all other patients (p=NS). None of the 8 patients admitted from home died within 14 days of first positive culture, as compared to 9/21 (43%) of all other patients (p=0.03 by Fisher's Exact). In a multivariable model which adjusted for chronic comorbidities (Charlson comorbidity index) and severe acute illness, community origin remained significantly associated with decreased mortality (p<0.01).
Conclusion: In this nested cohort of hospitalized patients with CRKP pneumonia, community origin prior to admission was associated with improved 14-day survival.
D. Van Duin,
S. S. Richter, None
K. Kaye, None
R. Salata, None
S. Evans, None
R. Bonomo, None
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