TY - JOUR
T1 - Hospital readmissions in patients with carbapenem resistant klebsiella pneumoniae
AU - Messina, Julia A.
AU - Cober, Eric
AU - Richter, Sandra S.
AU - Perez, Federico
AU - Salata, Robert A.
AU - Kalayjian, Robert C.
AU - Watkins, Richard R.
AU - Scalera, Nikole M.
AU - Doi, Yohei
AU - Kaye, Keith S.
AU - Evans, Scott
AU - Bonomo, Robert A.
AU - Fowler, Vance G.
AU - Van Duin, David
N1 - Publisher Copyright:
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved.
PY - 2015/12/7
Y1 - 2015/12/7
N2 - background. Various transmission routes contribute to spread of carbapenem-resistant Klebsiella pneumoniae (CRKP) in hospitalized patients. Patients with readmissions during which CRKP is again isolated (“CRKP readmission”) potentially contribute to transmission of CRKP. objective. To evaluate CRKP readmissions in the Consortium on Resistance against Carbapenems in K. pneumoniae (CRaCKLe). design. Cohort study from December 24, 2011, through July 1, 2013. setting. Multicenter consortium of acute care hospitals in the Great Lakes region. patients. All patients who were discharged alive during the study period were included. Each patient was included only once at the time of the first CRKP-positive culture. methods. All readmissions within 90 days of discharge from the index hospitalization during which CRKP was again found were analyzed. Risk factors for CRKP readmission were evaluated in multivariable models. results. Fifty-six (20%) of 287 patients who were discharged alive had a CRKP readmission. History of malignancy was associated with CRKP readmission (adjusted odds ratio [adjusted OR], 3.00 [95% CI, 1.32-6.65], P<.01). During the index hospitalization, 160 patients (56%) received antibiotic treatment against CRKP; the choice of regimen was associated with CRKP readmission (P =.02). Receipt of tigecycline-based therapy (adjusted OR, 5.13 [95% CI, 1.72-17.44], using aminoglycoside-based therapy as a reference in those treated with anti-CRKP antibiotics) was associated with CRKP readmission. conclusion. Hospitalized patients with CRKP—specifically those with a history of malignancy—are at high risk of readmission with recurrent CRKP infection or colonization. Treatment during the index hospitalization with a tigecycline-based regimen increases this risk.
AB - background. Various transmission routes contribute to spread of carbapenem-resistant Klebsiella pneumoniae (CRKP) in hospitalized patients. Patients with readmissions during which CRKP is again isolated (“CRKP readmission”) potentially contribute to transmission of CRKP. objective. To evaluate CRKP readmissions in the Consortium on Resistance against Carbapenems in K. pneumoniae (CRaCKLe). design. Cohort study from December 24, 2011, through July 1, 2013. setting. Multicenter consortium of acute care hospitals in the Great Lakes region. patients. All patients who were discharged alive during the study period were included. Each patient was included only once at the time of the first CRKP-positive culture. methods. All readmissions within 90 days of discharge from the index hospitalization during which CRKP was again found were analyzed. Risk factors for CRKP readmission were evaluated in multivariable models. results. Fifty-six (20%) of 287 patients who were discharged alive had a CRKP readmission. History of malignancy was associated with CRKP readmission (adjusted odds ratio [adjusted OR], 3.00 [95% CI, 1.32-6.65], P<.01). During the index hospitalization, 160 patients (56%) received antibiotic treatment against CRKP; the choice of regimen was associated with CRKP readmission (P =.02). Receipt of tigecycline-based therapy (adjusted OR, 5.13 [95% CI, 1.72-17.44], using aminoglycoside-based therapy as a reference in those treated with anti-CRKP antibiotics) was associated with CRKP readmission. conclusion. Hospitalized patients with CRKP—specifically those with a history of malignancy—are at high risk of readmission with recurrent CRKP infection or colonization. Treatment during the index hospitalization with a tigecycline-based regimen increases this risk.
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U2 - 10.1017/ice.2015.298
DO - 10.1017/ice.2015.298
M3 - Article
C2 - 26686227
AN - SCOPUS:84959184801
SN - 0899-823X
VL - 37
SP - 281
EP - 288
JO - Infection Control and Hospital Epidemiology
JF - Infection Control and Hospital Epidemiology
IS - 3
ER -