Association between rectal colonisation by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae and mortality: a prospective, observational study

Journal of Global Antimicrobial Resistance

Azahara Frutos-Adame¹  Marina Gallo-Marín²  Carmen de la Fuente²  Belén Gutiérrez-Gutiérrez²  Julián Torre-Cisneros²  Jesús Rodríguez-Baño²  Sabrina Mameli²  Julián Torre-Giménez²  Inmaculada Salcedo³  Alejandra M. Natera³  Manuel García-Gutiérrez³  María J. Artacho³  Luis Martínez-Martínez³  Irene Gracia-Ahufinger³  Ángela Cano³  Elena Pérez-Nadales³  Isabel Machuca⁴  Francisco Gómez-Delgado⁵  Juan José Castón⁵ 

[1] Corresponding author. Mailing address: Infectious Diseases Unit, Hospital Universitario Virgen Macarena–Instituto de Biomedicina de Sevilla (IBiS) and Department of Medicine, Universidad de Sevilla, Avda. Dr Fedriani 3, 41009 Seville, Spain.;Spanish Network of Research in Infectious Diseases (REIPI);Infectious Diseases Service, Hospital Universitario Reina Sofía–Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain;Infectious Diseases Service, Hospital Universitario Virgen Macarena–Instituto de Biomedicina de Sevilla (IBiS) and Department of Medicine, Universidad de Sevilla, Seville, Spain;Unit of Microbiology, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain;

关键词: Carbapenemase-producing Klebsiella pneumoniae;    KPC;    Colonisation;    Mortality;    Severe infection;   

DOI  :  

来源: DOAJ

【 摘 要 】

ABSTRACT:Objectives: We evaluated the association of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) rectal colonisation with crude mortality and whether this association is independent of the risk of KPC-Kp infection. Methods: This was a prospective cohort study of patients followed-up 90 days after a study of rectal colonisation. Cox regression was used to study the variables associated with crude mortality. Sensitivity analyses for 90-day crude mortality in different subcohorts were performed. Results: A total of 1244 patients (1078 non-colonised and 166 colonised) were included. None of the non-colonised patients and 78 (47.0%) of the colonised patients developed KPC-Kp infection. The 90-day crude mortality was 18.0% (194/1078) in non-colonised patients and 41.6% (69/166) in colonised patients. Rectal colonisation was not associated with crude mortality [hazard ratio (HR) = 1.03, 95% confidence interval (CI) 0.69–1.54; P = 0.85] when the model was adjusted for severe KPC-Kp infection [INCREMENT-CPE score (ICS) > 7]. KPC-Kp infection with ICS > 7 was associated with an increased risk of all-cause mortality (HR = 2.21, 95% CI 1.35–3.63; P = 0.002). In the sensitivity analyses, KPC-Kp colonisation was not associated with mortality in any of the analysed subcohorts, including patients who did not develop KPC-Kp infection (HR = 0.93, 95% CI 0.60–1.43; P = 0.74). Conclusion: KPC-Kp rectal colonisation was not associated with crude mortality. Mortality increased when colonised patients developed severe KPC-Kp infection (ICS > 7). Rectal colonisation was a necessary although insufficient condition to die from a KPC-Kp infection.

【 授权许可】

Unknown