Mathers, A;
Vesegana, K;
German Mesner, I;
Ainsworth, J;
Pannone, A;
Crook, D;
Sifri, C;
... Eyre, D; + view all
(2020)
Risk factors for Klebsiella pneumoniae carbapenemase (KPC) gene acquisition and clinical outcomes across multiple bacterial species.
Journal of Hospital Infection
, 104
(4)
pp. 456-468.
10.1016/j.jhin.2020.01.005.
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Abstract
Introduction: Risk-factors for carbapenemase-producing Enterobacteriales (CPE) acquisition/infection and associated clinical outcomes have been evaluated in the context of clonal, species-specific outbreaks; equivalent analyses for complex, multi-species outbreaks, which are increasingly common, are lacking. Methods: We performed a case-control study of Klebsiella pneumoniae carbapenemase (KPC)-producing organism (KPCO) acquisition using electronic health records from inpatients in a US academic medical center and long-term acute care hospital (LTACH), Dec 2010-Jan 2017, with ongoing multi-species KPCO transmission despite a robust CPE screening program. Cases had a first KPCO-positive culture >48 hours after admission, and included colonisations and infections (defined by clinical records). Controls had ≥2 negative peri-rectal screens and no positive cultures. Risk-factors for KPCO acquisition, first infection following acquisition, and 14-day mortality following each infection episode were identified using multivariable logistic regression. Results In 303 cases (89 with ≥1 infection) and 5929 controls, risk-factors for KPCO acquisition included: longer inpatient stay, transfusion, complex thoracic pathology, mechanical ventilation, dialysis, and exposure to carbapenems and β-lactam/β-lactamase inhibitors. Exposure to other KPCO-colonised patients was only a risk factor for acquisition in a single unit, suggesting that direct patient-to-patient transmission did not play a major role. There were 15 species of KPCO; 61 (20%) cases were colonised/infected with >1 species. 14-day mortality following non-urinary KPCO infection was 20% (20/97 episodes) and was associated with failure to achieve source control. Conclusions: Healthcare exposures, antimicrobials and invasive procedures increased risk of KPCO colonisation/infection suggesting potential targets for infection control interventions in multi-species outbreaks. Evidence for patient-to-patient transmission was limited.
| Type: | Article |
|---|---|
| Title: | Risk factors for Klebsiella pneumoniae carbapenemase (KPC) gene acquisition and clinical outcomes across multiple bacterial species |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.jhin.2020.01.005 |
| Publisher version: | https://doi.org/10.1016/j.jhin.2020.01.005 |
| Language: | English |
| Additional information: | This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
| Keywords: | Carbapenemase producing Enterobacteriales (CPE), Carbapenemase producing organisms (CPO), Klebsiella pneumoniae carbapenemase (KPC), multispecies clinical risk, carbapenem resistant Enterobacteriales (CRE) |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/10088866 |
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