Carbapenem-resistant Klebsiella pneumoniae is associated with poor outcome in hemodialysis patients

Summary Background Hemodialysis (HD) units have become a source of resistant bacteria. One of the most alarming developments is the emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP). Risk factors and outcomes of CRKP isolation in HD patients have not been previously studied. Methods A n...

Full description

Saved in:
Bibliographic Details
Published in:The Journal of infection 2012-10, Vol.65 (4), p.318-325
Main Authors: Bleumin, Dina, Cohen, Matan J, Moranne, Olivier, Esnault, Vincent L.M, Benenson, Shmuel, Paltiel, Ora, Tzukert, Keren, Mor-Yosef Levi, Irit, Ben-Dov, Iddo Z, Levi, Ronen, Bloch, Aharon, Haviv, Yosef S
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anti-Bacterial Agents - pharmacology
Antibacterial agents
Antibiotics. Antiinfectious agents. Antiparasitic agents
beta-Lactam Resistance
Biological and medical sciences
Carbapenems - pharmacology
Case-Control Studies
Emergency and intensive care: renal failure. Dialysis management
Female
Follow-Up Studies
General aspects
Hemodialysis
Humans
Infectious Disease
Intensive care medicine
Klebsiella Infections - epidemiology
Klebsiella Infections - microbiology
Klebsiella Infections - mortality
Klebsiella pneumoniae - drug effects
Klebsiella pneumoniae - isolation & purification
Klebsiella pneumoniae carbapenemase
Male
Medical sciences
Middle Aged
Multi-drug resistance
Pharmacology. Drug treatments
Prospective Studies
Renal Dialysis
Renal Insufficiency - complications
Renal Insufficiency - therapy
Risk Factors
Survival Analysis
Treatment Outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Summary Background Hemodialysis (HD) units have become a source of resistant bacteria. One of the most alarming developments is the emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP). Risk factors and outcomes of CRKP isolation in HD patients have not been previously studied. Methods A nested case–control study was conducted in maintenance HD patients between January 1st 2006 and June 30th 2009. CRKP-positive patients were matched with randomly selected CRKP-negative HD patients. Demographics, clinical and laboratory data were collected for 24 months prior to the specimen collection. Multivariate analyses identified independent risk factors for CRKP. A prospective follow-up determined CRKP-associated outcome. Results Demographics associated with CRKP acquisition in HD patients were age between 65 and 75 and having no living offspring. Clinical conditions associated with CRKP were previous hospitalization, temporary HD catheter and previous isolation of vancomycin-resistant enterococcus. CRKP-related outcome was poor: median survival of one month and a hazard ratio [95% CI] of 5.9 [3.2–11.0] for mortality. Conclusions Temporary HD catheters and previous treatment for VRE may predict subsequent CRKP isolation. A microbiological diagnosis of CRKP in HD patients is highly associated with imminent mortality. Meticulous measures to control the spread of CRKP bacteria among HD patients appear particularly warranted.
ISSN:0163-4453
1532-2742
DOI:10.1016/j.jinf.2012.06.005