Hospital readmissions in patients with carbapenem resistant klebsiella pneumoniae

Julia A. Messina, Eric Cober, Sandra S. Richter, Federico Perez, Robert A. Salata, Robert C. Kalayjian, Richard R. Watkins, Nikole M. Scalera, Yohei Doi, Keith S. Kaye, Scott Evans, Robert A. Bonomo, Vance G. Fowler, David Van Duin

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish
Pages (from-to)281-288
Number of pages8
JournalInfection Control and Hospital Epidemiology
Volume37
Issue number3
DOIs
Publication statusPublished - 07-12-2015

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Patient Readmission
Carbapenems
Klebsiella pneumoniae
Hospitalization
Great Lakes Region
Klebsiella Infections
Odds Ratio
Anti-Bacterial Agents
Aminoglycosides
Therapeutics

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Messina, J. A., Cober, E., Richter, S. S., Perez, F., Salata, R. A., Kalayjian, R. C., ... Van Duin, D. (2015). Hospital readmissions in patients with carbapenem resistant klebsiella pneumoniae. Infection Control and Hospital Epidemiology, 37(3), 281-288. https://doi.org/10.1017/ice.2015.298
Messina, Julia A. ; Cober, Eric ; Richter, Sandra S. ; Perez, Federico ; Salata, Robert A. ; Kalayjian, Robert C. ; Watkins, Richard R. ; Scalera, Nikole M. ; Doi, Yohei ; Kaye, Keith S. ; Evans, Scott ; Bonomo, Robert A. ; Fowler, Vance G. ; Van Duin, David. / Hospital readmissions in patients with carbapenem resistant klebsiella pneumoniae. In: Infection Control and Hospital Epidemiology. 2015 ; Vol. 37, No. 3. pp. 281-288.
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abstract = "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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Messina, JA, Cober, E, Richter, SS, Perez, F, Salata, RA, Kalayjian, RC, Watkins, RR, Scalera, NM, Doi, Y, Kaye, KS, Evans, S, Bonomo, RA, Fowler, VG & Van Duin, D 2015, 'Hospital readmissions in patients with carbapenem resistant klebsiella pneumoniae', Infection Control and Hospital Epidemiology, vol. 37, no. 3, pp. 281-288. https://doi.org/10.1017/ice.2015.298

Hospital readmissions in patients with carbapenem resistant klebsiella pneumoniae. / Messina, Julia A.; Cober, Eric; Richter, Sandra S.; Perez, Federico; Salata, Robert A.; Kalayjian, Robert C.; Watkins, Richard R.; Scalera, Nikole M.; Doi, Yohei; Kaye, Keith S.; Evans, Scott; Bonomo, Robert A.; Fowler, Vance G.; Van Duin, David.

In: Infection Control and Hospital Epidemiology, Vol. 37, No. 3, 07.12.2015, p. 281-288.

Research output: Contribution to journalArticle

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

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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