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. 2018 Oct;31(5):427-434.
Epub 2018 Sep 18.

[Risk factors and clinical evolution of carbapenemase-producing Klebsiella pneumoniae infections in a university hospital in Spain. Case-control study]

[Article in Spanish]
V Rojo  1 , P Vázquez  2 , S Reyes, L Puente Fuertes, M Cervero
Affiliations

[Risk factors and clinical evolution of carbapenemase-producing Klebsiella pneumoniae infections in a university hospital in Spain. Case-control study]

[Article in Spanish]
V Rojo et al. Rev Esp Quimioter. 2018 Oct.

Abstract
in English, Spanish

Objective: Carbapenemase-producing Enterobacterias is a global health hazard due to their ease of transmission, difficulty of treatment, and their personal and economic impact. We analyze the factors associated with an increased risk of infection by Klebsiella pneumoniae carbapenemase-producing bacteria (KPC) and factors related to poor prognosis.

Methods: We designed a case-control study. KPC isolates were taken during an outbreak in a hospital in Madrid. A logistic regression was performed with the main variables.

Results: Sixteen cases of clinically documented infections were isolated. Overall mortality rates in the cases group was 25%. The most frequent location was blood (37.5%) followed by urine (25%). All but one were OXA-48. Regarding factors related to an increased risk of developing infection, only previous exposure to antibiotics presented statistical significance difference OR 13 (2.40-70.46). With respect to the overall mortality, the presence of pneumonia OR 25 (1.93-323.55) or the use of invasive mechanical ventilation was associated with greater risk 15 OR 33 (1.92-122.8) For attributable mortality only invasive ventilation had a significant association OR 18 (1.48-218.95).

Conclusions: Exposure to previous antibiotics is an independent risk factor for developing KPC infection, adjusted for all other clinical and demographic variables. Risk factors such as the presence of pneumonia or the use of invasive mechanical ventilation were associated with a worse prognosis in terms of overall and attributable mortality.

Introducción: Las enterobacterias productoras de carbapenemasas son un problema de salud mundial debido a su facilidad de transmisión, la dificultad de tratamiento y su impacto económico y personal. Analizamos los factores asociados a un mayor riesgo de infección por Klebsiella pneumoniae productora de carbapenemasas (KPC) y los factores relacionados con peor pronóstico.

Material y métodos: estudio de casos y controles. Se tomaron los aislamientos de KPC durante un brote en un hospital del sur de Madrid. Con las variables se llevó a cabo una regresión logística.

Resultados: Se aislaron 16 casos causantes de infecciones clínicamente documentadas. La mortalidad global en los casos fue del 25%. La localización más frecuente fue sangre (37,5%), seguida de orina (25%). Todos, excepto uno fueron OXA-48. En cuanto a factores relacionados con mayor riesgo de desarrollar infección, únicamente la exposición previa a antibióticos presentó significación estadística OR 13 (2,40-70,46). Con respecto a la mortalidad global, se asoció a un mayor riesgo la presencia de neumonía OR 25 (1,93-323,55) o el empleo de ventilación mecánica invasiva 15,33 (1,92-122,8). Para la mortalidad atribuible solo la ventilación mecánica invasiva tuvo una asociación significativa OR 18 (1,48-218,95).

Conclusiones: La exposición a antibióticos previos es un factor de riesgo independiente de desarrollar una infección por KPC, ajustado por el resto de variables clínicas y demográficas. Factores de riesgo como la presencia de neumonía o el empleo de ventilación mecánica invasiva se relacionaron con un peor pronóstico en términos de mortalidad global y atribuible.

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Conflict of interest statement

Los autores declaran no tener ningún conflicto de intereses.

Figures

Figura 1
Figura 1
Diagrama de flujo para la selección de casos/controles.
Figura 2
Figura 2
Curva epidemiológicak del brote desde octubre 2013 a diciembre 2015.
Figura 3
Figura 3
Distribución de los aislamientos de KPC por servicio.
See this image and copyright information in PMC

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