Tumbarello Mario, Trecarichi Enrico Maria, Tumietto Fabio, Del Bono Valerio, De Rosa Francesco Giuseppe, Bassetti Matteo, Losito Angela Raffaella, Tedeschi Sara, Saffioti Carolina, Corcione Silvia, Giannella Maddalena, Raffaelli Francesca, Pagani Nicole, Bartoletti Michele, Spanu Teresa, Marchese Anna, Cauda Roberto, Viscoli Claudio, Viale Pierluigi
Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Rome, Italy
Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Rome, Italy.
Antimicrob Agents Chemother. 2014 Jun;58(6):3514-20. doi: 10.1128/AAC.02373-13. Epub 2014 Apr 14.
The production of Klebsiella pneumoniae carbapenemases (KPCs) by Enterobacteriaceae has become a significant problem in recent years. To identify factors that could predict isolation of KPC-producing K. pneumoniae (KPCKP) in clinical samples from hospitalized patients, we conducted a retrospective, matched (1:2) case-control study in five large Italian hospitals. The case cohort consisted of adult inpatients whose hospital stay included at least one documented isolation of a KPCKP strain from a clinical specimen. For each case enrolled, we randomly selected two matched controls with no KPCKP-positive cultures of any type during their hospitalization. Matching involved hospital, ward, and month/year of admission, as well as time at risk for KPCKP isolation. A subgroup analysis was also carried out to identify risk factors specifically associated with true KPCKP infection. During the study period, KPCKP was isolated from clinical samples of 657 patients; 426 of these cases appeared to be true infections. Independent predictors of KPCKP isolation were recent admission to an intensive care unit (ICU), indwelling urinary catheter, central venous catheter (CVC), and/or surgical drain, ≥ 2 recent hospitalizations, hematological cancer, and recent fluoroquinolone and/or carbapenem therapy. A Charlson index of ≥ 3, indwelling CVC, recent surgery, neutropenia, ≥ 2 recent hospitalizations, and recent fluoroquinolone and/or carbapenem therapy were independent risk factors for KPCKP infection. Models developed to predict KPCKP isolation and KPCKP infection displayed good predictive power, with the areas under the receiver-operating characteristic curves of 0.82 (95% confidence interval [CI], 0.80 to 0.84) and 0.82 (95% CI, 0.80 to 0.85), respectively. This study provides novel information which might be useful for the clinical management of patients harboring KPCKP and for controlling the spread of this organism.
近年来，肠杆菌科细菌产生肺炎克雷伯菌碳青霉烯酶（KPCs）已成为一个重大问题。为了确定可预测住院患者临床样本中产KPC的肺炎克雷伯菌（KPCKP）分离情况的因素，我们在意大利五家大型医院开展了一项回顾性、匹配（1:2）病例对照研究。病例队列包括成年住院患者，其住院期间至少有一次从临床标本中记录到KPCKP菌株的分离。对于每一例入选病例，我们随机选择两名匹配的对照，他们在住院期间没有任何类型的KPCKP阳性培养物。匹配因素包括医院、病房、入院月份/年份，以及KPCKP分离的风险时间。还进行了亚组分析，以确定与真正的KPCKP感染特别相关的危险因素。在研究期间，从657例患者的临床样本中分离出KPCKP；其中426例似乎是真正的感染。KPCKP分离的独立预测因素包括近期入住重症监护病房（ICU）、留置导尿管、中心静脉导管（CVC）和/或手术引流管、近期≥2次住院、血液系统癌症，以及近期使用氟喹诺酮类和/或碳青霉烯类药物治疗。Charlson指数≥3、留置CVC、近期手术、中性粒细胞减少、近期≥2次住院，以及近期使用氟喹诺酮类和/或碳青霉烯类药物治疗是KPCKP感染的独立危险因素。用于预测KPCKP分离和KPCKP感染的模型显示出良好的预测能力，受试者工作特征曲线下面积分别为0.82（95%置信区间[CI]，0.80至0.84）和0.82（95%CI，0.80至0.85）。本研究提供了新的信息，可能有助于对携带KPCKP的患者进行临床管理以及控制该病原体的传播。
