Lessons from an outbreak of metallo-β-lactamase-producing Klebsiella oxytoca in an intensive care unit: the importance of time at risk and combination therapy
| Autor: | M. C. Conejo, Álvaro Pascual, S. Vergara-López, M.C. Domínguez, Jesús Rodríguez-Baño |
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| Rok vydání: | 2013 |
| Předmět: |
Microbiology (medical)
Male medicine.medical_specialty Klebsiella Time Factors Context (language use) Carbapenem-resistant enterobacteriaceae Logistic regression beta-Lactam Resistance beta-Lactamases law.invention Time at risk law Internal medicine Epidemiology medicine Humans Prospective Studies Intensive care medicine Aged Proportional Hazards Models Cross Infection biology business.industry Klebsiella oxytoca Outbreak General Medicine Middle Aged biology.organism_classification Intensive care unit Anti-Bacterial Agents Klebsiella Infections Intensive Care Units Infectious Diseases Spain Case-Control Studies Drug Therapy Combination Female business |
| Zdroj: | The Journal of hospital infection. 89(2) |
| ISSN: | 1532-2939 |
| Popis: | Summary Background Outbreaks of nosocomial infection due to carbapenem-resistant Enterobacteriaceae (CRE), mostly Klebsiella spp., have become a worldwide phenomenon. Aim To investigate the risk factors for the acquisition of clonal multidrug-resistant Klebsiella oxytoca (MDRKO) producing the metallo-β-lactamase IMP-8 and hyperproducing chromosomal OXY-2 β-lactamase during a well-characterized outbreak, and to describe the clinical features of infections due to MDRKO. Methods A four-wave outbreak due to MDRKO occurred in the intensive care unit of a Spanish hospital between 2009 and 2011. The risk factors for acquisition of MDRKO during waves 1 and 2 (in which colonized patients served as the main reservoir for the epidemic strain) were analysed using a case–control study by Cox regression and logistic regression analysis. Clinical data and treatments of patients infected with MDRKO were also analysed. Findings For the study of risk factors, 26 cases and 45 controls were studied. None of the variables studied in the Cox regression analysis showed an association with MDRKO acquisition; time at risk was the only associated variable by logistic regression analysis. Colonization pressure was not associated with earlier acquisition. Overall, 14 patients were infected with MDRKO; ventilator-associated pneumonia (seven patients) was the most frequent type of infection. Monotherapy tended to be associated with higher mortality than combination therapy [60% (3/5) vs 16.6% (1/6); P = 0.07]. Conclusions Time at risk was the most significant risk determinant for the acquisition of carbapenem-resistant Enterobacteriaceae (CRE) in this epidemiological context and should be included in any study of risk factors for the acquisition of multidrug-resistant bacteria. Combination therapy may be superior to monotherapy for the treatment of CRE infections. |
| Databáze: | OpenAIRE |
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