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https://hdl.handle.net/10495/29526
Título : | Risk factors and survival of patients infected with carbapenem-resistant Klebsiella pneumoniae in a KPC endemic setting: a case-control and cohort study |
Autor : | Cienfuegos Gallet, Astrid Vanessa Ocampo de Los Ríos, Ana María Sierra Viana, Patricia María Ramírez Brinez, Faiver Restrepo Castro, Carlos Andrés Roncancio Villamil, Gustavo Corral Londoño, Helena del Jiménez Quiceno, Judy Natalia |
metadata.dc.subject.*: | Estudios de Casos y Controles Case-Control Studies Estudios de Cohortes Cohort Studies Klebsiella pneumoniae Factores de Riesgo Risk Factors Mortalidad Mortality Carbapenémicos Carbapenems Farmacorresistencia Microbiana Drug Resistance, Microbial |
Fecha de publicación : | 2019 |
Editorial : | BMC (BioMed Central) |
Resumen : | ABSTRACT : Background: Many gaps in the burden of resistant pathogens exist in endemic areas of low- and middle-income economies, especially those endemic for carbapenem resistance. The aim of this study is to evaluate risk factors for carbapenem-resistance, to estimate the association between carbapenem-resistance and all-cause 30-day mortality and to examine whether mortality is mediated by inappropriate therapy. Methods: A case-control and a cohort study were conducted in one tertiary-care hospital in Medellín, Colombia from 2014 to 2015. Phenotypic and genotypic characterization of isolates was performed. In the case-control study, cases were defined as patients infected with carbapenem-resistant K. pneumoniae (CRKP) and controls as patients infected with carbapenem-susceptible K. pneumoniae (CSKP). A risk factor analysis was conducted using logistic regression models. In the cohort study, the exposed group was defined as patients infected with CRKP and the non-exposed group as patients infected with CSKP. A survival analysis using an accelerated failure time model with a lognormal distribution was performed to estimate the association between carbapenem resistance and all-cause 30-day-mortality and to examine whether mortality is mediated by inappropriate therapy. Results: A total of 338 patients were enrolled; 49 were infected with CRKP and 289 with CSKP. Among CRKP isolates CG258 (n = 29), ST25 (n = 5) and ST307 (n = 4) were detected. Of importance, every day of meropenem (OR 1.18, 95%CI 1.10–1.28) and cefepime (OR 1.22, 95%CI 1.03–1.49) use increase the risk of carbapenem resistance. Additional risk factors were previous use of ciprofloxacin (OR 2.37, 95%CI 1.00–5.35) and urinary catheter (OR 2.60, 95%CI 1.25–5.37). Furthermore, a significant lower survival time was estimated for patients infected with CRKP compared to CSKP (Relative Times 0.44, 95%CI 0.24–0.82). The strength of association was reduced when appropriate therapy was included in the model (RT = 0.81 95%CI 0.48–1.37). Conclusion: Short antibiotic courses had the potential to reduce the selection and transmission of CRKP. A high burden in mortality occurred in patients infected with CRKP in a KPC endemic setting and CRKP leads to increased mortality via inappropriate antibiotic treatment. Furthermore, dissemination of recognized hypervirulent clones could add to the list of challenges for antibiotic resistance control. |
metadata.dc.identifier.eissn: | 1471-2334 |
metadata.dc.identifier.doi: | 10.1186/s12879-019-4461-x |
Aparece en las colecciones: | Artículos de Revista en Microbiología |
Ficheros en este ítem:
Fichero | Descripción | Tamaño | Formato | |
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CienfuegosAstrid_2019_RiskFactorsSurvival.pdf | Artículo de investigación | 7.47 MB | Adobe PDF | Visualizar/Abrir |
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