Risk factors for Healthcare-Associated Infections caused by KPC-producing Enterobacteriaceae: a case-control study
Abstract
Objective: To evaluate the risk factors for healthcare-associated infections caused by Klebsiella pneumoniae carbapenemase producing Enterobacteriaceae.
Method: This is a retrospective case-control study that consisted of a sample of 82 infected patients and 164 controls, totaling 246 patients. Data collection was performed between January and May 2017 through search in the Automated Hospital Infection Control System and in the electronic patient records.
Results: Patients previously colonized with gram-negative microorganisms (OR: 10.7, 95% CI: 2-60, p=0.007), with cancer (OR: 20.8, 95% CI: 4-120, p<0.001), using a double lumen catheter (OR: 30.5, 95% CI: 2-382, p=0.008), with pressure injury (OR: 136.2, 95% CI: 11- 1623, p<0.001) and Intensive Care Unit stay (OR: 1.4, 95% CI: 1.2-1.6, p <0.001) had a greater chance of developing Healthcare-associated Infections caused by KPC-producing Enterobacteriaceae than the control group. The area under the ROC curve showed a good overall performance (0.99, 95% CI: 0.992-0.998) of the final logistic regression model.
Conclusion: Previous colonization, cancer, double lumen catheter use, pressure injury and ICU stay were very important risk factors for the acquisition of infections in the hospital environment.
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References
Monteiro J, Santos AF. First Report of KPC-2-Producing Klebsiella pneumoniae Strains in Brazil. Antimicrob Agents Chemother [Internet]. 2009 [cited 2018 Fev 14];53(1):333-34. DOI: http://dx.doi.org/10.1128/AAC.00736-08
World Health Organization. Antimicrobial resistance Global Report on Surveillance. Geneva: World Health Organization [Internet]. 2014 [cited 2018 Fev 14]. Available from: https://www.who.int/drugresistance/documents/surveillancereport/en/
Centers for Disease Control and Prevention. Facility Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE). CRE Toolkit. Atlanta [Internet]. CDC; 2015 [cited 2018 Fev 14]. Available from: https://www.cdc.gov/hai/pdfs/cre/CRE-guidance-508.pdf
Mariappan S, Sekar U, Kamalanathan A. Carbapenemase-producing Enterobacteriaceae: Risk factors for infection and impact of resistance on outcomes. Int J Appl Basic Med Res [Internet]. 2017 [cited 2018 Fev 14];7(1):32-39. DOI: http://dx.doi.org/10.4103/2229-516X.198520
Abboud CS, de Souza EE, Zandonadi EC, Borges LS, Miglioli L, Monaco FC, et al. Carbapenem-resistant Enterobacteriaceae on a cardiac surgery intensive care unit: successful measures for infection control. J Hosp Infect [Internet]. 2016 [cited 2018 Fev 14];94(1):60-4. DOI: http://dx.doi.org/10.1016/j.jhin.2016.06.010
Wang Q, Zhang Y, Yao X, Xian H, Liu Y, Li H, et al. Risk factors and clinical outcomes for carbapenem-resistant Enterobacteriaceae nosocomial infections. Eur J Clin Microbiol Infect Dis [Internet]. 2016 [cited 2018 Fev 15];35(10):1679-89. DOI: http://dx.doi.org/10.1007/s10096-016-2710-0
Agência Nacional de Vigilância Sanitária. Nota Técnica nº 01/2013 – Medidas de prevenção e controle de infecções por Enterobactérias multiresistentes. Brasília: ANVISA [Internet]. 2013 [cited 2018 Fev 14]. Available from: http://portal.anvisa.gov.br/documents/33852/271858/Nota+t%C3%A9cnica+n%C2%BA+01+de+2013/5be89853-7eca-4b4b-98e4-5096b9f5a2ec
Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Disk Susceptibility Tests; Approved Standard—Eleventh Edition. CLSI document M02-A11. Wayne, PA: Clinical and Laboratory Standards Institute [Internet]. 2012 [cited 2018 Fev 14]. Available from: https://clsi.org/about/about-clsi/about-clsi-antimicrobial-and-antifungal-susceptibility-testing-resources/
Borges FK, Moraes TA, Drebes CVE, Silva ALT, Cassol R, Falci DR. Perfil dos pacientes colonizados por enterobactérias produtoras de KPC em hospital terciário de Porto Alegre, Brasil. Clin Biomed Res [Internet]. 2015 [cited 2018 Fev 15];35(1). DOI: http://dx.doi.org/10.4322/2357-9730.51134
Carrilho C, Oliveira LM, Gaudereto J, Perozin JS, Urbano MR, Camargo CH, et al. A prospective study of treatment of carbapenem-resistant Enterobacteriaceae infections and risk factors associated with outcome. BMC Infect Dis [Internet]. 2016 [cited 2018 Fev 15];16:629. DOI: http://dx.doi.org/10.1186/s12879-016-1979-z
Giacobbe DR, Del Bono V, Trecarichi EM, De Rosa FG, Giannella M, Bassetti M, et al. Risk factors for bloodstream infections due to colistin-resistant KPC-producing Klebsiella pneumoniae: results from a multicenter case-control-control study. Clin Microbiol Infect [Internet]. 2015 [cited 2018 Fev 16];21(12):1106.e1-8. DOI: http://dx.doi.org/10.1016/j.cmi.2015.08.001
Souza ES, Belei RA, Carrilho CMDM, Matsuo T, Yamada-Ogatta SF, Andrade G, et al. Mortalidade e riscos associados a infecção relacionada à assistência à saúde. Texto Contexto Enferm [Internet]. 2015 [cited 2018 Fev 16]; 24(1):220-8. DOI: http://dx.doi.org/10.1590/0104-07072015002940013
Lubert C, Becker-Rux D, Rodloff AC, Laudi S, Busch T, Bartels M, et al. Colonization of liver transplant recipients with KPC-producing Klebsiella pneumoniae is associated with high infection rates and excess mortality: a case-control analysis. Infection [Internet]. 2014 [cited 2018 Fev 15];42(2):309-16. DOI: http://dx.doi.org/10.1007/s15010-013-0547-3
Papadimitrious-Olivgeris M, Marangos M, Fligou F, Christofidou M, Bartzavali C, Anastassiou ED, et al. Risk factors for KPC-producing Klebsiella pneumoniae enteric colonization upon ICU admission. J Antimicrob Chemother [Internet]. 2012 [cited 2018 Fev 16];67(12):2976-81. DOI: http://dx.doi.org/10.1093/jac/dks316
Cronin KM, Poy Lorenzo YS, Olenski ME, Bloch AE, Visvanathan K, Waters MJ, et al. Risk factors for KPC-producing Enterobacteriaceae acquisition and infection in a healthcare setting with possible local transmission: a case-control study. J Hosp Infect [Internet]. 2017 [cited 2018 Fev 16];96(2):111-15. DOI: http://dx.doi.org/10.1016/j.jhin.2017.02.010
Papadimitrious-Olivgeris M, Marangos M, Fligou F, Christofidou M, Sklavou C, Vamvakopoulou S, et al. KPC-producing Klebsiella pneumoniae enteric colonization acquired during intensive care unit stay: the significance of risk factors for its development and its impact on mortality. Diagn Microbiol Infect Dis [Internet]. 2013 [cited 2018 Fev 15];77(2):169-73. DOI: http://dx.doi.org/10.1016/j.diagmicrobio.2013.06.007
Ling ML, Tee YM, Tan SG, Amim IM, How KB, Tan KY, et al. Risk factors for acquisition of carbapenem resistant Enterobacteriaceae in an acute tertiary care hospital in Singapore. Antimicrob Resist Infect Control [Internet]. 2015 [cited 2018 Fev 16];4:26. DOI: http://dx.doi.org/10.1186/s13756-015-0066-3
Tumbarello M, Trecarichi EM, De Rosa FG, Giannella M, Giacobbe DR, Bassetti M, et al. Infections caused by KPC-producing Klebsiella pneumoniae: differences in therapy and mortality in a multicentre study. J Antimicrob Chemother [Internet]. 2015 [cited 2018 Fev 18];70(7):2133-43. DOI: http://dx.doi.org/10.1093/jac/dkv086
Murri R, Fiori B, Spanu T, Mastrorosa I, Giovannenze F, Taccari F, et al. Trimethoprim-sulfamethoxazole therapy for patients with carbapenemase-producing Klebsiella pneumoniae infections: retrospective single-center case series. Infection [Internet]. 2017 [cited 2018 Fev 18];45(2):209-213. DOI: http://dx.doi.org/10.1007/s15010-016-0968-x
Borghardt AT, Prado TN, Bicudo SDS, Castrol DS, BringuenteI ME. Pressure ulcers in critically ill patients: incidence and associated factors. Rev Bras Enferm [Internet]. 2016 [cited 2018 Fev 15];69(3):460-67. DOI: http://dx.doi.org/10.1590/0034-7167.2016690307i
Meatherall B, Gregson D, Ross T, Pitout JD, Laupland KB. Incidence, risk factors, and outcomes of Klebsiella pneumoniae bacteremia. Am J Med [Internet]. 2009 [cited 2018 Fev 16];122(9):866-73. DOI: http://dx.doi.org/10.1016/j.amjmed.2009.03.034
Guerra MR, Bustamante-Teixeira MT, Corrêa CSL, Bustamante-Teixeira MT, Corrêa CSL , Abreu DMX, Curado MP, Mooney M, et al. Magnitude e variação da carga da mortalidade por câncer no Brasil e Unidades da Federação, 1990 e 2015. Rev Bras Epidemiol [Internet]. 2017 [cited 2018 Fev 16];20(Suppl 1):102-15. DOI: http://dx.doi.org/10.1590/1980-5497201700050009
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