+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Carbapenem-resistant Klebsiella pneumoniae in high-risk haematological patients: factors favouring spread, risk factors and outcome of carbapenem-resistant Klebsiella pneumoniae bacteremias

Carbapenem-resistant Klebsiella pneumoniae in high-risk haematological patients: factors favouring spread, risk factors and outcome of carbapenem-resistant Klebsiella pneumoniae bacteremias

Bmc Infectious Diseases 17(1): 203

Label="BACKGROUND">Carbapenem-resistant Klebsiella pneumoniae (CRKP) spread and infections in patients with haematological malignancies are a serious concern especially in endemic areas. Treatment failures and delay in appropriate therapy for CRKP infections are frequent and the mortality rate associated with CRKP bacteremia in neutropenic haematological patients is reported about 60%.Label="METHODS">Haematological patients harboring CRKP hospitalized between February 2012 and May 2013 in an Italian Teaching hospital were examined. Conditions favouring CRKP spread in a haematological unit, risk factors for bacteremia in CRKP-carriers and for CRKP bacteremia-related death were evaluated in this observational retrospective study.Label="RESULTS">CRKP was isolated in 22 patients, 14 (64%) had bacteremia. Control measures implementation, particularly the weekly rectal screening for CRKP performed in all hospitalized patients and contact precautions for CRKP-carriers and newly admitted patients until proved CRKP-negative, reduced significantly the CRKP spread (14 new carriers identified of 131 screened patients vs 5 of 242 after the intervention, p = 0.001). Fifty-eight percent of carriers developed CRKP bacteremia, and acute myeloid leukemia (AML) resulted independently associated with the bacteremia occurrence (p = 0.02). CRKP bacteremias developed mainly during neutropenia (86%) and in CRKP-carriers (79%). CRKP bacteremias were breakthrough in 10 cases (71%). Ten of 14 patient with CRKP bacteremias died (71%) and all had AML. The 70% of fatal bacteremias occurred in patients not yet recognized as CRKP-carriers and 80% were breakthrough. Initial adequate antibiotic therapy resulted the only independent factor able to protect against death (p = 0.02).Label="CONCLUSIONS">The identification of CRKP-carriers is confirmed critical to prevent CRKP spread. AML patients colonized by CRKP resulted at high risk of CRKP-bacteremia and poor outcome and the adequacy of the initial antibiotic therapy may be effective to improve survival. To limit the increase of resistance, the extensive use of antibiotics active against CRKP should be avoided, but in the setting of high CRKP pressure and high-risk CRKP-colonized haematological patients, timely empiric antibiotic combinations active against CRKP could be suggested as treatment of febrile neutropenia.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 059468650

Download citation: RISBibTeXText

PMID: 28283020

DOI: 10.1186/s12879-017-2297-9

Related references

Risk factors for developing clinical infection with carbapenem-resistant Klebsiella pneumoniae in hospital patients initially only colonized with carbapenem-resistant K pneumoniae. American Journal of Infection Control 40(5): 421-425, 2012

Risk factors for the acquisition of colistin and carbapenem-resistant Klebsiella pneumoniae in Medelln-Colombia, an endemic region for carbapenem resistance. International Journal of Infectious Diseases 53: 39-40, 2016

Risk factors for the acquisition of carbapenem-resistant Klebsiella pneumoniae among hospitalized patients. Microbial Drug Resistance 11(2): 165-169, 2005

A retrospective study of risk factors for carbapenem-resistant Klebsiella pneumoniae acquisition among ICU patients. Journal of Infection in Developing Countries 10(3): 208-213, 2016

Risk Factors for Carbapenem-resistant Klebsiella pneumoniae Infection and Mortality of Klebsiella pneumoniae Infection. Chinese Medical Journal 131(1): 56-62, 2018

Risk factors for the acquisition of nosocomial infection with carbapenem-resistant Klebsiella pneumoniae. Southern Medical Journal 104(2): 106-110, 2011

Risk factors of carbapenem-resistant Klebsiella pneumoniae infection: a serious threat in ICUs. Medical Science Monitor 21: 219-224, 2015

Risk Factors for Carbapenem-Resistant Klebsiella pneumoniae Infection: A Meta-Analysis. Microbial Drug Resistance 24(2): 190-198, 2018

A hospital-based matched case-control study to identify clinical outcome and risk factors associated with carbapenem-resistant Klebsiella pneumoniae infection. Bmc Infectious Diseases 13: 80-80, 2013

Carbapenem-Resistant Klebsiella pneumoniae: Results of a Laboratory Surveillance Program in an Italian General Hospital (August 2014-January 2015) : Surveillance of Carbapenem-resistant Klebsiella pneumoniae. Advances in Experimental Medicine and Biology 901: 91, 2016

Risk factors for infections due to carbapenem-resistant Klebsiella pneumoniae after open heart surgery. Interactive Cardiovascular and Thoracic Surgery 23(5): 762-768, 2016

Risk factors for carbapenem resistant Klebsiella pneumoniae rectal colonization in pediatric units. Journal of Infection in Developing Countries 8(10): 1361-1364, 2014

Molecular Epidemiology and Risk Factors of Carbapenem-Resistant Klebsiella pneumoniae Infections in Eastern China. Frontiers in Microbiology 8: 1061, 2017

Risk factors and outcomes of carbapenem-resistant Klebsiella pneumoniae infections in liver transplant recipients. Liver Transplantation 22(5): 698-699, 2016

Risk factors and mortality in the Carbapenem-resistant Klebsiella pneumoniae infection: case control study. Pathogens and Global Health 110(7-8): 321-325, 2016