Prospective study of Klebsiella pneumoniae bacteremia:<br /> Risk factors and clinical significance of type VIM-1 metallo-beta-lactamases
Journal Title: Αρχεία Ελληνικής Ιατρικής - Year 2009, Vol 26, Issue 3
Abstract
OBJECTIVE VIM-1-producing K. pneumoniae (VPKP) is an emerging pathogen causing life-threatening infections. This study was conducted to identify the factors associated with bloodstream infections (BSI) caused by VPKP and to evaluate the importance of VIM production on outcome. METHOD A prospective observational study was conducted in three tertiary care hospitals located in Athens, Greece, from 2004 to 2006. Consecutive patients with K. pneumoniae BSI were identified and monitored until discharge or death. Pertinent information was abstracted in a predesigned form. Antimicrobial susceptibility testing was performed by Etest. Microbial characteristics, including MBL production, blaVIM gene carriage and chromosomal types were examined. The data were analyzed to assess for risk factors associated with VPKP BSIs and 14-day mortality. RESULTS A total of 178 patients with Klebsiella pneumoniae BSIs were identified; 67 (37.6%) were infected with a VPKP and 111 with a non-VPKP. MICs of imipenem for VPKP varied from the susceptible range to high-level resistance; 19 isolates were resistant to imipenem and 48 susceptible, whereas none of the non-VPKP exhibited resistance to carbapenems. VPKP were invariably multi-drug resistant. Prior use of carbapenems (OR 4.14; 95% CI 1.75-9.81; P=0.001) and stay in an intensive care unit (ICU) (OR 9.32; 95% CI 3.91-22.20; P<0.01) were independently associated with VPKP BSIs. Overall, patients infected with a VPKP had mortality rates similar to those infected with a non-VPKP. MIC of imipenem >4 μg/mL (OR 4.27; 95% CI 1.41-12.95; P=0.01), older age (OR 1.03; 95% CI 1.00-1.05; P=0.03) and rapidly fatal underlying disease (OR 3.15; 95% CI 1.23-8.04; P=0.016) were independently associated with 14-day mortality. CONCLUSIONS VPKP have spread widely in Greece and cause life-threatening infections, mainly in ICU patients who have had prior exposure to carbapenems. VPKP BSIs are associated with high mortality rates when the infecting organism is resistant to carbapenems.
Authors and Affiliations
P. PETRIKKOS, C. KOSMIDIS, L. TZOUVELEKIS, A. AVLAMIS, I. STEFANOU, E. PLATSOUKA, O. PANIARA, M. TOUTOUZA, K. GEORGOUSI, G. PETRIKKOS
Keywords
Related Articles
- EP ID EP113172
- DOI -
- Views 112
- Downloads 0
Assessment of health-related quality of life for diabetic patients type 2 <br /> <br />
OBJECTIVE Diabetes mellitus type 2 (DM-2) places a huge strain on health and is a major cause of morbidity and mortality. The increasing prevalence of the disease has reached epidemic proportions lately. Measuring health...
Making clinical decisions under risk. <br /> The meaning of utility, prospect and regret <br /> <br />
In this article, the utility theory and its refinements (prospect theory, cumulative prospect theory) and the regret theory is reviewed. The incorporation of qualified and measured patient preferences (utilities) regardi...
Τhe different faces of plagiarism
No abstract available
Arterial blood gas analyzers. Which is appropriate for point of care testing in the critical care unit?
OBJECTIVE Arterial blood gas analysis is a basic laboratory investigation in the critical care unit. In the past, a big problem in critical care management was the waiting period for arterial blood gas results from the l...
Prevention of cardiovascular diseases. Alma-Ata 1978 and today. <br /> What has been achieved and what should be expected?
A review of the world situation and the events of the preceding 20 years, along with the socioeconomic conditions prevailing world-wide in the late 1970s, led WHO officials to the decision to call an international meetin...