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Observational Study
. 2022 Jun:29:476-482.
doi: 10.1016/j.jgar.2021.10.024. Epub 2021 Nov 14.

Association between rectal colonisation by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae and mortality: a prospective, observational study

Ángela Cano  1 , Belén Gutiérrez-Gutiérrez  2 , Isabel Machuca  1 , Julián Torre-Giménez  3 , Azahara Frutos-Adame  3 , Manuel García-Gutiérrez  3 , Marina Gallo-Marín  3 , Irene Gracia-Ahufinger  4 , María J Artacho  4 , Alejandra M Natera  1 , Elena Pérez-Nadales  1 , Juan José Castón  1 , Sabrina Mameli  5 , Francisco Gómez-Delgado  6 , Carmen de la Fuente  7 , Inmaculada Salcedo  8 , Jesús Rodríguez-Baño  9 , Luis Martínez-Martínez  10 , Julián Torre-Cisneros  11
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Free article
Observational Study

Association between rectal colonisation by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae and mortality: a prospective, observational study

Ángela Cano et al. J Glob Antimicrob Resist. 2022 Jun.
Free article

Abstract

Objectives: We evaluated the association of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) rectal colonisation with crude mortality and whether this association is independent of the risk of KPC-Kp infection.

Methods: This was a prospective cohort study of patients followed-up 90 days after a study of rectal colonisation. Cox regression was used to study the variables associated with crude mortality. Sensitivity analyses for 90-day crude mortality in different subcohorts were performed.

Results: A total of 1244 patients (1078 non-colonised and 166 colonised) were included. None of the non-colonised patients and 78 (47.0%) of the colonised patients developed KPC-Kp infection. The 90-day crude mortality was 18.0% (194/1078) in non-colonised patients and 41.6% (69/166) in colonised patients. Rectal colonisation was not associated with crude mortality [hazard ratio (HR) = 1.03, 95% confidence interval (CI) 0.69-1.54; P = 0.85] when the model was adjusted for severe KPC-Kp infection [INCREMENT-CPE score (ICS) > 7]. KPC-Kp infection with ICS > 7 was associated with an increased risk of all-cause mortality (HR = 2.21, 95% CI 1.35-3.63; P = 0.002). In the sensitivity analyses, KPC-Kp colonisation was not associated with mortality in any of the analysed subcohorts, including patients who did not develop KPC-Kp infection (HR = 0.93, 95% CI 0.60-1.43; P = 0.74).

Conclusion: KPC-Kp rectal colonisation was not associated with crude mortality. Mortality increased when colonised patients developed severe KPC-Kp infection (ICS > 7). Rectal colonisation was a necessary although insufficient condition to die from a KPC-Kp infection.

Keywords: Carbapenemase-producing Klebsiella pneumoniae; Colonisation; KPC; Mortality; Severe infection.

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Conflict of interest statement

Declaration of Competing Interests JRB has served as a scientific advisor for a research project for AstraZeneca, Pfizer and InfectoPharm, as a speaker in unrestricted accredited educational activities funded by Merck and has obtained funding from the Spanish Ministry of Economy and Competitiveness, the Carlos III Health Institute (ISCIII); BGG has a contract to intensify the research activity associated with the project P18/01849 (Carlos III Health Institute); JTC has served as scientific advisor for a research/consensus project for Pfizer, as an expert in a consensus document for InfectoPharm and has received payment for lectures including service on speakers bureaus and for the development of educational presentations for Pfizer, AstraZeneca, Shionogi and Merck; AC has received honoraria for the development of educational presentations for Pfizer and Shionogi. All other authors declare no competing interests.

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