Hoxha A, Kärki T, Giambi C, Montano C, Sisto A, Bella A, D'Ancona F
Università Cattolica del Sacro Cuore, Rome, Italy.
Istituto Superiore di Sanità (ISS), National Centre for Epidemiology Surveillance and Health Promotion (CNESPS), Rome, Italy; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
J Hosp Infect. 2016 Jan;92(1):61-6. doi: 10.1016/j.jhin.2015.06.018. Epub 2015 Jul 29.
In Italy, infections with carbapenem-resistant Klebsiella pneumoniae (CRKP) have increased markedly since 2009, creating unprecedented problems in healthcare settings and limiting treatment options for infected patients.
To assess the attributable mortality due to CRKP in ten Italian hospitals and to describe the clinical characteristics of patients with an invasive CRKP and carbapenem-susceptible K. pneumoniae (CSKP) infection.
We conducted a matched cohort study, and calculated crude and attributable mortality for CRKP. The attributable mortality was calculated by subtracting the crude mortality rate of the patients with CSKP from the crude mortality rate of the patients with CRKP. We also described the clinical characteristics of CRKP and CSKP patients and analysed the determinants of mortality by using conditional Poisson regression.
The study included 98 patients, 49 with CRKP and 49 with CSKP. CRKP patients had undergone more invasive procedures and also tended to have more serious conditions, measured by higher Simplified Acute Physiology Score II. The attributable mortality of CRKP at 30 days was 41%. CRKP patients were three times more likely to die within 30 days [matched incidence rate ratio (mIRR): 3.0; 95% confidence interval (CI): 1.5-6.1]. Adjusting for potential confounders, the risk remained the same (adjusted mIRR: 3.0; 95% CI: 1.3-7.1).
CRKP infection had a marked effect on patient mortality, even after adjusting for other patient characteristics. To control the spread of CRKP we recommend prioritization of control measures in hospitals where CRKP is found.
在意大利，自2009年以来，耐碳青霉烯类肺炎克雷伯菌（CRKP）感染显著增加，给医疗机构带来了前所未有的问题，并限制了感染患者的治疗选择。
评估意大利十家医院中CRKP所致的归因死亡率，并描述侵袭性CRKP感染和碳青霉烯类敏感肺炎克雷伯菌（CSKP）感染患者的临床特征。
我们进行了一项匹配队列研究，并计算了CRKP的粗死亡率和归因死亡率。归因死亡率通过用CRKP患者的粗死亡率减去CSKP患者的粗死亡率来计算。我们还描述了CRKP和CSKP患者的临床特征，并使用条件泊松回归分析了死亡率的决定因素。
该研究纳入了98例患者，49例为CRKP感染患者，49例为CSKP感染患者。CRKP感染患者接受了更多的侵入性操作，并且病情往往更严重，通过更高的简化急性生理学评分II来衡量。CRKP在第30天的归因死亡率为41%。CRKP感染患者在30天内死亡的可能性是CSKP感染患者的三倍[匹配发病率比（mIRR）：3.0；95%置信区间（CI）：1.5 - 6.1]。在调整潜在混杂因素后，风险仍然相同（调整后的mIRR：3.0；95%CI：1.3 - 7.1）。
即使在调整了其他患者特征后，CRKP感染对患者死亡率仍有显著影响。为了控制CRKP传播，我们建议在发现CRKP的医院优先采取控制措施。
