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Attributable mortality rate for carbapenem-resistant Klebsiella pneumoniae bacteremia.

Abstract：

OBJECTIVE:To determine the attributable (direct) mortality and morbidity caused by carbapenem-resistant Klebsiella pneumoniae bacteremia. DESIGN:A matched retrospective, historical cohort design, using a stepwise procedure to stringently match the best control subjects to the best case subjects. SETTING:A 1,000-bed tertiary-care university teaching hospital. PATIENTS:Case subjects were defined as adult patients with carbapenem-resistant K. pneumoniae bacteremia during the period from October 2005 through October 2008. Control subjects were defined as patients who were very similar to case subjects except that they did not have bacteremia. METHODS:Matching potential control subjects to case subjects was performed at a 1:1 ratio using a computerized record system. The criteria used included same hospitalization period, similar Charlson comorbidity index, same underlying disease, same age within 10 years, and same sex. Demographic and clinical characteristics were collected from medical records. RESULTS:During the study period, 319 patients developed an infection due to carbapenem-resistant K. pneumoniae. Of these 319 patients, 39 (12.2%) developed a bloodstream infection, for an overall rate of 0.59 episodes of carbapenem-resistant K. pneumoniae bacteremia per 10,000 patient-days. We excluded 7 patients from our study, leaving a total of 32 case subjects in our cohort. Case subjects were significantly more likely than control subjects (n = 32) to require care in an intensive care unit (12 case subjects [37.5%] vs 3 control subjects [9.4%]), ventilator support (17 case subjects [53.1%] vs 8 control subjects [25%]), and use of a central venous catheter (19 case subjects [59.4%] vs 9 control subjects [28.1%]). For case subjects, the crude mortality rate was 71.9% (ie, 23 of the 32 case subjects died); for control subjects, the crude mortality rate was 21.9% (ie, 7 of the 32 control subjects died) (P < .001. For case subjects, the attributable mortality was 50% (95% confidence interval [CI], 15.3%-98.6%). A mortality risk ratio of 3.3 (95% CI, 2.9-28.5) was found for case subjects with carbapenem-resistant K. pneumoniae bacteremia. CONCLUSIONS:Patients with carbapenem-resistant K. pneumoniae require more intensive and invasive care. We have shown that the crude and attributable mortality rates associated with carbapenem-resistant K. pneumoniae bacteremia were striking.

journal_name

Infect Control Hosp Epidemiol

journal_title

Infection control and hospital epidemiology

authors

Borer A,Saidel-Odes L,Riesenberg K,Eskira S,Peled N,Nativ R,Schlaeffer F,Sherf M

doi

10.1086/605922

subject

Has Abstract

pub_date

2009-10-01 00:00:00

pages

972-6

issue

eissn

0899-823X

issn

1559-6834

pii

S0195941700037796

journal_volume

pub_type

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Attributable mortality rate for carbapenem-resistant Klebsiella pneumoniae bacteremia.