Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
J Microbiol Immunol Infect. 2012 Apr;45(2):113-9. doi: 10.1016/j.jmii.2011.09.026. Epub 2011 Dec 11.
Carbapenem-resistant Klebsiella pneumoniae is an emerging problem worldwide. The object of this study was to investigate the risk factors, characteristics and outcomes of ertapenem-nonsusceptible K pneumoniae (ENSKp) bacteremia.
We conducted a 1:2 ratio matched case-control study. The controls were randomly selected among patients with ertapenem-susceptible K pneumoniae (ESKp) bacteremia and were matched with ENSKp cases for bacteremia.
Seventy-five patients were included in this study (25 cases and 50 controls). Bivariate analysis showed that prior exposure to either β-Lactam/β-Lactam-lactamase inhibitors (p = 0.008) or 4(th) generation cephalosporins (p < 0.001), chronic obstructive pulmonary disease (COPD) (p = 0.001), acute renal failure (p = 0.021), chronic kidney disease without dialysis (p = 0.021), recent hospital stay (p = 0.016), intensive care unit stay (p = 0.002), mechanical ventilation (p = 0.003), central venous catheter placement (p = 0.016), Foley indwelling (p = 0.022), polymicrobial bacteremia (p = 0.003) and higher Pittsburgh bacteremia score (p < 0.001) were associated with ENSKp bacteremia. The multivariate analysis showed that prior exposure to 4(th) generation cephalosporins (odds ratio [OR], 28.05; 95% confidence interval [CI], 2.92-269.85; p = 0.004), COPD (OR, 21.38; 95% CI, 2.95-154.92; p = 0.002) and higher Pittsburgh bacteremia score (OR, 1.35; 95% CI, 1.10-1.66; p = 0.004) were independent factors for ENSKp bacteremia. ENSKp bacteremia had a higher 14-day mortality rate than ESKp bacteremia (44.0% vs. 22.0%; p = 0.049). The overall in-hospital mortality rates for these two groups were 60.0% and 40.0% respectively (p = 0.102).
ENSKp bacteremia had a poor outcome and the risk factors were prior exposure of 4(th) generation cephalosporins, COPD and higher Pittsburgh bacteremia score. Antibiotic stewardship may be the solution for the preventive strategy.
耐碳青霉烯类肺炎克雷伯菌是全球范围内一个新出现的问题。本研究的目的是探讨厄他培南不敏感肺炎克雷伯菌（ENSKp）菌血症的危险因素、特征和结局。
我们进行了 1:2 比例的病例对照研究。对照组是从厄他培南敏感肺炎克雷伯菌（ESKp）菌血症患者中随机选择的，并与 ENSKp 病例进行了菌血症匹配。
本研究共纳入 75 例患者（25 例病例和 50 例对照）。单因素分析显示，先前暴露于β-内酰胺/β-内酰胺酶抑制剂（p = 0.008）或第 4 代头孢菌素（p < 0.001）、慢性阻塞性肺疾病（COPD）（p = 0.001）、急性肾损伤（p = 0.021）、无透析慢性肾脏病（p = 0.021）、近期住院（p = 0.016）、重症监护病房入住（p = 0.002）、机械通气（p = 0.003）、中心静脉导管置管（p = 0.016）、 Foley 留置（p = 0.022）、混合菌血症（p = 0.003）和较高的匹兹堡菌血症评分（p < 0.001）与 ENSKp 菌血症相关。多因素分析显示，先前暴露于第 4 代头孢菌素（比值比[OR]，28.05；95%置信区间[CI]，2.92-269.85；p = 0.004）、COPD（OR，21.38；95%CI，2.95-154.92；p = 0.002）和较高的匹兹堡菌血症评分（OR，1.35；95%CI，1.10-1.66；p = 0.004）是 ENSKp 菌血症的独立危险因素。ENSKp 菌血症的 14 天死亡率高于 ESKp 菌血症（44.0% vs. 22.0%；p = 0.049）。两组患者的总住院死亡率分别为 60.0%和 40.0%（p = 0.102）。
ENSKp 菌血症预后不良，危险因素为第 4 代头孢菌素、COPD 和较高的匹兹堡菌血症评分。抗生素管理可能是预防策略的解决方案。
