Infectious Diseases Service, Hospital Universitario Reina Sofía-Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain; Spanish Network of Research in Infectious Diseases (REIPI).
Infectious Diseases Service, Hospital Universitario Virgen Macarena-Instituto de Biomedicina de Sevilla (IBiS) and Department of Medicine, Universidad de Sevilla, Seville, Spain; Spanish Network of Research in Infectious Diseases (REIPI).
J Glob Antimicrob Resist. 2022 Jun;29:476-482. doi: 10.1016/j.jgar.2021.10.024. Epub 2021 Nov 14.
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.
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.
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).
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.
我们评估了产碳青霉烯酶肺炎克雷伯菌（KPC-Kp）直肠定植与粗死亡率之间的关系，以及这种关系是否独立于 KPC-Kp 感染的风险。
这是一项前瞻性队列研究，对直肠定植后 90 天的患者进行随访。使用 Cox 回归分析与粗死亡率相关的变量。对不同亚组 90 天粗死亡率进行敏感性分析。
共纳入 1244 例患者（1078 例未定植和 166 例定植）。未定植的患者中无一例发生 KPC-Kp 感染，而定植的患者中有 78 例（47.0%）发生 KPC-Kp 感染。未定植患者的 90 天粗死亡率为 18.0%（194/1078），定植患者的粗死亡率为 41.6%（69/166）。当模型调整为严重 KPC-Kp 感染（INCREMENT-CPE 评分（ICS）>7）时，直肠定植与粗死亡率无关（风险比[HR]1.03，95%置信区间[CI]0.69-1.54；P=0.85）。ICS>7 的 KPC-Kp 感染与全因死亡率增加相关（HR 2.21，95%CI 1.35-3.63；P=0.002）。在敏感性分析中，KPC-Kp 定植与任何分析亚组的死亡率均无关，包括未发生 KPC-Kp 感染的患者（HR 0.93，95%CI 0.60-1.43；P=0.74）。
KPC-Kp 直肠定植与粗死亡率无关。当定植患者发生严重 KPC-Kp 感染（ICS>7）时，死亡率增加。直肠定植是发生 KPC-Kp 感染导致死亡的必要条件，但不充分。
