The prevalence of multi-drug resistant organisms (MDRO) is on the rise globally. MDRO infections carry high morbidity and mortality. There is a paucity of data on Carbapenem-resistant Klebsiella pneumoniae (CRKp) in the Dominican Republic (DR). Evaluating CRKp in various settings will provide data on contrasting epidemiologic risk factors. We evaluated the epidemiology of CKRp in three contrasting settings, a 495-bed urban academic center (AC), a 151-bed urban community hospital (CH) and a 200 bed teaching hospital in the DR (DRH).
We performed a retrospective cohort study of patients with CRKp cultures from 2014-16 from AC, CH and DRH. A comparative evaluation of the epidemiology of CRKp between the cohorts was performed. Demographics, co-morbid conditions, antibiotic sensitivity, and outcomes were compared between hospital cohorts.
Cohort AC had 64 patients, compared to 8 from CH and 8 from DRH. AC (59%) and CH (62%) cohorts included more men than the DRH cohort (25%). Average age was 62, 66 and 51 respectively. History of MDRO, antibiotic use in the past 6 months and hospitalization within the past year were common risk factors (Figure 1). Diabetes and end-stage renal disease were common comorbidities at all facilities (Figure 2). Charleston Comorbidity Index (CCI) score was highest at AC (6.6) and DRH (6.4) compared to CH (4). Mortality was highest in DRH (63%, 6/8) and AC (11%, 7/64) while CH had no deaths. Urine was the most common source at AC (67%) and CH (75%) while blood was most common at DRH (62.5%). CRKp isolates were susceptible to colistin at varying rates (AC=85%, CH=63%, DRH=80%).
Figure 1. Common risk factors for CRKp between facilities
Figure 2. Common patient comorbidities for CRKp between facilities
Prior antibiotic use and hospitalization were common risk factors in all settings. Mortality and CCI scores for CRKp was highest at AC and DRH, which are tertiary referral centers. CH had less overall mortality and higher rates of colistin resistance. Further studies are needed to understand these risk factors. Strengthening antimicrobial stewardship and infection control practices in the US and abroad may help curb the spread of resistance in different clinical settings.
A. J. Mena Lora,
A. Guzman, None
S. Borgetti, None
S. C. Bleasdale, None
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