Program Schedule

Use of Tigecycline in Patients with Carbapenem-resistant Klebsiella pneumoniae (CRKP) is Associated with Increased Risk for Readmissions with CRKP

Session: Oral Abstract Session: New Insights into the Prevention and Control of MDR GNR
Saturday, October 11, 2014: 3:00 PM
Room: The Pennsylvania Convention Center: 109-AB

Background:   Carbapenem Resistant Klebsiella Pneumoniae (CRKP) is an emerging threat, and hospital readmissions of patients with persistent or recurrent CRKP may contribute to the spread of CRKP.  We evaluated CRKP readmissions in the Consortium on Resistance against Carbapenems in K. pneumoniae (CRaCKle).

Methods:   CRaCKle is a prospective multicenter consortium which includes 21 hospitals in the Great Lakes region.  All hospitalized patients who were discharged alive were included, if their hospitalization during which CRKP was isolated began and ended between 12/24/2011 and 7/1/2013.  Each patient was included once at the time of the first CRKP positive culture.  Standard criteria were used to define infection.  All readmissions during which CRKP was again found (“CRKP readmission”) were documented.  Risk factors for CRKP readmission were evaluated in multivariable logistic models.  Kaplan-Meier curve was used to compare time to readmission.

Results:   287 unique patients were included; 109 (38%) with CRKP infection.  Most CRKP was recovered from urine (192, 67%).  56 (20%) patients had a CRKP readmission within 90 days.  Risk factors for CRKP readmission included history of cancer (OR 2.74 95%CI 1.22-5.96, p=0.01), and renal insufficiency (OR 2.06, 95%CI 1.05-3.96, p=0.03).  160/287 (56%) of patients received anti-CRKP antibiotic treatment during their index hospitalization.  In these 160 patients, 65/160 (41%) received aminoglycoside-based regimens, 49/160 (31%) tigecycline-based regimens, 27/160 (17%) colistin-based regimens, and 19/160 (12%) other regimens.  Receiving a tigecycline-based regimen was associated with an increased risk for CRKP readmission; 14/49 (28%) of patients who received tigecycline were readmitted within 90 days, as compared to 16/111 (14%) of all other treatment regimens.  The OR for tigecycline for 90-day CRKP readmission was 2.71 (95%CI 1.14-6.48, p=0.02) after adjusting for infection status, source, renal failure, and cancer history.

Conclusion:   Hospitalized patients with CRKP are at high risk of readmission with recurrent CRKP which may contribute to the spread of CRKP in health care systems.  Treatment during index hospitalization with a tigecycline-based regimen may increase that risk.

Julia Messina, Duke University, Durham, NC, Eric Cober, MD, Infectious Disease, Cleveland Clinic, Cleveland, OH, Sandra S. Richter, MD, Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, OH, Keith Kaye, MD, MPH, FIDSA, FSHEA, Wayne State University, Detroit, MI, Robert Salata, MD, University Hospitals Case Medical Center, Cleveland, OH, Scott Evans, PhD, Center for Biostatistics in AIDS Research, Harvard University, Boston, MA, Robert Bonomo, MD, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, Vance Fowler, MD, Duke University Medical Center, Durham, NC and David Van Duin, MD, PhD, Medicine, University of North Carolina, Chapel Hill, NC


J. Messina, None

E. Cober, None

S. S. Richter, None

K. Kaye, Forest Laboratories, Inc.: Consultant, Grant Investigator and Speaker's Bureau, Consulting fee, Grant recipient and Speaker honorarium

R. Salata, None

S. Evans, None

R. Bonomo, AstraZeneca: Grant Investigator, Grant recipient
Merck: Grant Investigator, Grant recipient
Rib-X: Grant Investigator, Grant recipient
Steris: Grant Investigator, Grant recipient
TetraPhase: Scientific Advisor, nothing
NIH: Grant Investigator, Grant recipient
VA Merit Review: Grant Investigator, Grant recipient

V. Fowler, None

D. Van Duin, None

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