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