Ny Pamela, Nieberg Paul, Wong-Beringer Annie
Department of Pharmacy, Huntington Hospital, Pasadena, CA.
Division of Infectious Diseases, Department of Medicine, Huntington Hospital, Pasadena, CA.
Am J Infect Control. 2015 Oct 1;43(10):1076-80. doi: 10.1016/j.ajic.2015.06.008. Epub 2015 Jul 17.
Although high mortality associated with carbapenem-resistant Klebsiella pneumoniae (CRKP) bacteremia has been well described, the epidemiology and outcomes of nonbacteremic infection are unknown.
Medical charts of adults hospitalized for CRKP pneumonia or urinary tract infection between January 2011 and December 2013 were reviewed retrospectively for relevant demographic and clinical details. Cases were matched to controls (non-carbapenem-resistant, non-extended-spectrum beta-lactamase [ESBL]-producing K pneumoniae [NRKP]) by the primary site of infection and year of isolation and compared in terms of risk of acquisition and outcomes.
The CRKP and NRKP arms (n = 48 each) were elderly (median age, 74 years). Compared with controls, more patients in the CRKP arm resided in skilled nursing/long-term acute care facilities (77% vs 29%; P < .01), had a chronic tracheostomy (29% vs 0%; P < .001), decubitus ulcers (69% vs 17%; P < .01), higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores (median, 21.5 vs 14; P = .02), and required intensive care unit admission (54% vs 31%; P = .04). More patients in the CRKP arm had previous ESBL infection (23% vs 6%; P = .04), and this arm had at least a 10-fold greater risk of coinfection with other carbapenem-resistant pathogens (44% vs 4%; P < .01), as well as a 7-fold greater likelihood of previous carbapenem therapy (23% vs 4%; P = .01). Patients in the CRKP arm had prolonged hospitalization (median, 13 days) and a 32% rate of readmission within 30 days of discharge.
CRKP nonbacteremic infections occur in debilitated patients and are associated with frequent previous carbapenem exposure and high resource utilization, underscoring the need to focus efforts on antimicrobial stewardship and infection control.
尽管耐碳青霉烯类肺炎克雷伯菌（CRKP）菌血症相关的高死亡率已有详尽描述，但非菌血症性感染的流行病学及转归尚不清楚。
回顾性分析2011年1月至2013年12月因CRKP肺炎或尿路感染住院的成年患者的病历，获取相关人口统计学和临床细节。根据感染的主要部位和分离年份，将病例与对照组（非耐碳青霉烯类、非产超广谱β-内酰胺酶[ESBL]的肺炎克雷伯菌[NRKP]）进行匹配，并比较获得感染的风险和转归。
CRKP组和NRKP组（每组n = 48）均为老年患者（中位年龄74岁）。与对照组相比，CRKP组更多患者居住在专业护理/长期急性护理机构（77%对29%；P <.01），有慢性气管切开术（29%对0%；P <.001）、褥疮（69%对17%；P <.01），急性生理与慢性健康状况评分系统（APACHE）II评分更高（中位数21.5对14；P = 0.02），且需要入住重症监护病房（54%对31%；P = 0.04）。CRKP组更多患者既往有ESBL感染（23%对6%；P = 0.04），该组合并其他耐碳青霉烯类病原体感染的风险至少高10倍（44%对4%；P <.01），既往接受碳青霉烯类治疗的可能性也高7倍（23%对4%；P = 0.01）。CRKP组患者住院时间延长（中位数13天），出院后30天内再入院率为32%。
CRKP非菌血症性感染发生于身体衰弱的患者，且与既往频繁接触碳青霉烯类及高资源利用相关，这凸显了将工作重点放在抗菌药物管理和感染控制上的必要性。
