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. 2014 Oct 15;9(10):e110001.
doi: 10.1371/journal.pone.0110001. eCollection 2014.

Comorbidities and disease severity as risk factors for carbapenem-resistant Klebsiella pneumoniae colonization: report of an experience in an internal medicine unit

Antonio Nouvenne  1 , Andrea Ticinesi  1 , Fulvio Lauretani  2 , Marcello Maggio  3 , Giuseppe Lippi  4 , Loredana Guida  5 , Ilaria Morelli  5 , Erminia Ridolo  1 , Loris Borghi  1 , Tiziana Meschi  1
Affiliations

Comorbidities and disease severity as risk factors for carbapenem-resistant Klebsiella pneumoniae colonization: report of an experience in an internal medicine unit

Antonio Nouvenne et al. PLoS One. .

Abstract

Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an emerging multidrug-resistant nosocomial pathogen, spreading to hospitalized elderly patients. Risk factors in this setting are unclear. Our aims were to explore the contribution of multi-morbidity and disease severity in the onset of CRKP colonization/infection, and to describe changes in epidemiology after the institution of quarantine-ward managed by staff-cohorting.

Methods and findings: With a case-control design, we evaluated 133 CRKP-positive patients (75 M, 58 F; mean age 79 ± 10 years) and a control group of 400 CRKP-negative subjects (179 M, 221 F; mean age 79 ± 12 years) admitted to Internal Medicine and Critical Subacute Care Unit of Parma University Hospital, Italy, during a 10-month period. Information about comorbidity type and severity, expressed through Cumulative Illness Rating Scale-CIRS, was collected in each patient. During an overall 5-month period, CRKP-positive patients were managed in an isolation ward with staff cohorting. A contact-bed isolation approach was established in the other 5 months. The effects of these strategies were evaluated with a cross-sectional study design. CRKP-positive subjects had higher CIRS comorbidity index (12.0 ± 3.6 vs 9.1 ± 3.5, p < 0.0001) and CIRS severity index (3.2 ± 0.4 vs 2.9 ± 0.5, p < 0.0001), along with higher cardiovascular, respiratory, renal and neurological disease burden than control group. CIRS severity index was associated with a higher risk for CRKP-colonization (OR 13.3, 95% CI6.88-25.93), independent of comorbidities. Isolation ward activation was associated with decreased monthly incidence of CRKP-positivity (from 16.9% to 1.2% of all admissions) and infection (from 36.6% to 22.5% of all positive cases; p = 0.04 derived by Wilcoxon signed-rank test). Mortality rate did not differ between cases and controls (21.8% vs 15.2%, p = 0.08). The main limitations of this study are observational design and lack of data about prior antibiotic exposure.

Conclusions: Comorbidities and disease severity are relevant risk factors for CRKP-colonization/infection in elderly frail patients. Sanitary measures may have contributed to limit epidemic spread and rate of infection also in internal medicine setting.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Summary of the study design.
Figure 2
Figure 2. Trend in monthly incidence of CRKP positive cases in the period studied.
(CRKP  =  Carbapenemase-resistant Klebsiella pneumoniae).
Figure 3
Figure 3. Comparison of mean monthly incidence of new cases of CRKP positivity between quarantine ward management period and general ward management period.
Statistical analysis performed with analysis of variance. (CRKP  =  Carbapenemase-resistant Klebsiella pneumoniae).
See this image and copyright information in PMC

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