Spectrum of excess mortality due to carbapenem-resistant Klebsiella pneumoniae infections

Antibacterial Resistance Leadership Group

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Patients infected or colonized with carbapenem-resistant Klebsiella pneumoniae (CRKp) are often chronically and acutely ill, which results in substantial mortality unrelated to infection. Therefore, estimating excess mortality due to CRKp infections is challenging. The Consortium on Resistance against Carbapenems in K. pneumoniae (CRACKLE) is a prospective multicenter study. Here, patients in CRACKLE were evaluated at the time of their first CRKp bloodstream infection (BSI), pneumonia or urinary tract infection (UTI). A control cohort of patients with CRKp urinary colonization without CRKp infection was constructed. Excess hospital mortality was defined as mortality in cases after subtracting mortality in controls. In addition, the adjusted hazard ratios (aHR) for time-to-hospital-mortality at 30 days associated with infection compared with colonization were calculated in Cox proportional hazard models. In the study period, 260 patients with CRKp infections were included in the BSI (90 patients), pneumonia (49 patients) and UTI (121 patients) groups, who were compared with 223 controls. All-cause hospital mortality in controls was 12%. Excess hospital mortality was 27% in both patients with BSI and those with pneumonia. Excess hospital mortality was not observed in patients with UTI. In multivariable analyses, BSI and pneumonia compared with controls were associated with aHR of 2.59 (95% CI 1.52–4.50, p <0.001) and 3.44 (95% CI 1.80–6.48, p <0.001), respectively. In conclusion, in patients with CRKp infection, pneumonia is associated with the highest excess hospital mortality. Patients with BSI have slightly lower excess hospital mortality rates, whereas excess hospital mortality was not observed in hospitalized patients with UTI.

Original languageEnglish
Pages (from-to)513-519
Number of pages7
JournalClinical Microbiology and Infection
Volume22
Issue number6
DOIs
Publication statusPublished - 01-06-2016

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Klebsiella Infections
Carbapenems
Klebsiella pneumoniae
Hospital Mortality
Mortality
Pneumonia
Urinary Tract Infections
Infection
Proportional Hazards Models

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Antibacterial Resistance Leadership Group. / Spectrum of excess mortality due to carbapenem-resistant Klebsiella pneumoniae infections. In: Clinical Microbiology and Infection. 2016 ; Vol. 22, No. 6. pp. 513-519.
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abstract = "Patients infected or colonized with carbapenem-resistant Klebsiella pneumoniae (CRKp) are often chronically and acutely ill, which results in substantial mortality unrelated to infection. Therefore, estimating excess mortality due to CRKp infections is challenging. The Consortium on Resistance against Carbapenems in K. pneumoniae (CRACKLE) is a prospective multicenter study. Here, patients in CRACKLE were evaluated at the time of their first CRKp bloodstream infection (BSI), pneumonia or urinary tract infection (UTI). A control cohort of patients with CRKp urinary colonization without CRKp infection was constructed. Excess hospital mortality was defined as mortality in cases after subtracting mortality in controls. In addition, the adjusted hazard ratios (aHR) for time-to-hospital-mortality at 30 days associated with infection compared with colonization were calculated in Cox proportional hazard models. In the study period, 260 patients with CRKp infections were included in the BSI (90 patients), pneumonia (49 patients) and UTI (121 patients) groups, who were compared with 223 controls. All-cause hospital mortality in controls was 12{\%}. Excess hospital mortality was 27{\%} in both patients with BSI and those with pneumonia. Excess hospital mortality was not observed in patients with UTI. In multivariable analyses, BSI and pneumonia compared with controls were associated with aHR of 2.59 (95{\%} CI 1.52–4.50, p <0.001) and 3.44 (95{\%} CI 1.80–6.48, p <0.001), respectively. In conclusion, in patients with CRKp infection, pneumonia is associated with the highest excess hospital mortality. Patients with BSI have slightly lower excess hospital mortality rates, whereas excess hospital mortality was not observed in hospitalized patients with UTI.",
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Spectrum of excess mortality due to carbapenem-resistant Klebsiella pneumoniae infections. / Antibacterial Resistance Leadership Group.

In: Clinical Microbiology and Infection, Vol. 22, No. 6, 01.06.2016, p. 513-519.

Research output: Contribution to journalArticle

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