Comorbidities and disease severity as risk factors for carbapenem-resistant Klebsiella pneumoniae colonization: report of an experience in an internal medicine unit.
BACKGROUND: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an emerging multidrug-resistant nosocomial pathogen, spreading to hospitalized elderly patients. Risk factors in this setting are unclear. Our aims were to explore the contribution of multi-morbidity and disease severity in the onset o...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2014-01-01
|
| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC4198186?pdf=render |
| _version_ | 1818850663634829312 |
|---|---|
| author | Antonio Nouvenne Andrea Ticinesi Fulvio Lauretani Marcello Maggio Giuseppe Lippi Loredana Guida Ilaria Morelli Erminia Ridolo Loris Borghi Tiziana Meschi |
| author_facet | Antonio Nouvenne Andrea Ticinesi Fulvio Lauretani Marcello Maggio Giuseppe Lippi Loredana Guida Ilaria Morelli Erminia Ridolo Loris Borghi Tiziana Meschi |
| author_sort | Antonio Nouvenne |
| collection | DOAJ |
| description | BACKGROUND: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an emerging multidrug-resistant nosocomial pathogen, spreading to hospitalized elderly patients. Risk factors in this setting are unclear. Our aims were to explore the contribution of multi-morbidity and disease severity in the onset of CRKP colonization/infection, and to describe changes in epidemiology after the institution of quarantine-ward managed by staff-cohorting. METHODS AND FINDINGS: With a case-control design, we evaluated 133 CRKP-positive patients (75 M, 58 F; mean age 79 ± 10 years) and a control group of 400 CRKP-negative subjects (179 M, 221 F; mean age 79 ± 12 years) admitted to Internal Medicine and Critical Subacute Care Unit of Parma University Hospital, Italy, during a 10-month period. Information about comorbidity type and severity, expressed through Cumulative Illness Rating Scale-CIRS, was collected in each patient. During an overall 5-month period, CRKP-positive patients were managed in an isolation ward with staff cohorting. A contact-bed isolation approach was established in the other 5 months. The effects of these strategies were evaluated with a cross-sectional study design. CRKP-positive subjects had higher CIRS comorbidity index (12.0 ± 3.6 vs 9.1 ± 3.5, p < 0.0001) and CIRS severity index (3.2 ± 0.4 vs 2.9 ± 0.5, p < 0.0001), along with higher cardiovascular, respiratory, renal and neurological disease burden than control group. CIRS severity index was associated with a higher risk for CRKP-colonization (OR 13.3, 95% CI6.88-25.93), independent of comorbidities. Isolation ward activation was associated with decreased monthly incidence of CRKP-positivity (from 16.9% to 1.2% of all admissions) and infection (from 36.6% to 22.5% of all positive cases; p = 0.04 derived by Wilcoxon signed-rank test). Mortality rate did not differ between cases and controls (21.8% vs 15.2%, p = 0.08). The main limitations of this study are observational design and lack of data about prior antibiotic exposure. CONCLUSIONS: Comorbidities and disease severity are relevant risk factors for CRKP-colonization/infection in elderly frail patients. Sanitary measures may have contributed to limit epidemic spread and rate of infection also in internal medicine setting. |
| first_indexed | 2024-12-19T06:52:43Z |
| format | Article |
| id | doaj.art-d8aa7f6f395e46f6b93e3306117b590e |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-19T06:52:43Z |
| publishDate | 2014-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-d8aa7f6f395e46f6b93e3306117b590e2022-12-21T20:31:39ZengPublic Library of Science (PLoS)PLoS ONE1932-62032014-01-01910e11000110.1371/journal.pone.0110001Comorbidities and disease severity as risk factors for carbapenem-resistant Klebsiella pneumoniae colonization: report of an experience in an internal medicine unit.Antonio NouvenneAndrea TicinesiFulvio LauretaniMarcello MaggioGiuseppe LippiLoredana GuidaIlaria MorelliErminia RidoloLoris BorghiTiziana MeschiBACKGROUND: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an emerging multidrug-resistant nosocomial pathogen, spreading to hospitalized elderly patients. Risk factors in this setting are unclear. Our aims were to explore the contribution of multi-morbidity and disease severity in the onset of CRKP colonization/infection, and to describe changes in epidemiology after the institution of quarantine-ward managed by staff-cohorting. METHODS AND FINDINGS: With a case-control design, we evaluated 133 CRKP-positive patients (75 M, 58 F; mean age 79 ± 10 years) and a control group of 400 CRKP-negative subjects (179 M, 221 F; mean age 79 ± 12 years) admitted to Internal Medicine and Critical Subacute Care Unit of Parma University Hospital, Italy, during a 10-month period. Information about comorbidity type and severity, expressed through Cumulative Illness Rating Scale-CIRS, was collected in each patient. During an overall 5-month period, CRKP-positive patients were managed in an isolation ward with staff cohorting. A contact-bed isolation approach was established in the other 5 months. The effects of these strategies were evaluated with a cross-sectional study design. CRKP-positive subjects had higher CIRS comorbidity index (12.0 ± 3.6 vs 9.1 ± 3.5, p < 0.0001) and CIRS severity index (3.2 ± 0.4 vs 2.9 ± 0.5, p < 0.0001), along with higher cardiovascular, respiratory, renal and neurological disease burden than control group. CIRS severity index was associated with a higher risk for CRKP-colonization (OR 13.3, 95% CI6.88-25.93), independent of comorbidities. Isolation ward activation was associated with decreased monthly incidence of CRKP-positivity (from 16.9% to 1.2% of all admissions) and infection (from 36.6% to 22.5% of all positive cases; p = 0.04 derived by Wilcoxon signed-rank test). Mortality rate did not differ between cases and controls (21.8% vs 15.2%, p = 0.08). The main limitations of this study are observational design and lack of data about prior antibiotic exposure. CONCLUSIONS: Comorbidities and disease severity are relevant risk factors for CRKP-colonization/infection in elderly frail patients. Sanitary measures may have contributed to limit epidemic spread and rate of infection also in internal medicine setting.http://europepmc.org/articles/PMC4198186?pdf=render |
| spellingShingle | Antonio Nouvenne Andrea Ticinesi Fulvio Lauretani Marcello Maggio Giuseppe Lippi Loredana Guida Ilaria Morelli Erminia Ridolo Loris Borghi Tiziana Meschi Comorbidities and disease severity as risk factors for carbapenem-resistant Klebsiella pneumoniae colonization: report of an experience in an internal medicine unit. PLoS ONE |
| title | Comorbidities and disease severity as risk factors for carbapenem-resistant Klebsiella pneumoniae colonization: report of an experience in an internal medicine unit. |
| title_full | Comorbidities and disease severity as risk factors for carbapenem-resistant Klebsiella pneumoniae colonization: report of an experience in an internal medicine unit. |
| title_fullStr | Comorbidities and disease severity as risk factors for carbapenem-resistant Klebsiella pneumoniae colonization: report of an experience in an internal medicine unit. |
| title_full_unstemmed | Comorbidities and disease severity as risk factors for carbapenem-resistant Klebsiella pneumoniae colonization: report of an experience in an internal medicine unit. |
| title_short | Comorbidities and disease severity as risk factors for carbapenem-resistant Klebsiella pneumoniae colonization: report of an experience in an internal medicine unit. |
| title_sort | comorbidities and disease severity as risk factors for carbapenem resistant klebsiella pneumoniae colonization report of an experience in an internal medicine unit |
| url | http://europepmc.org/articles/PMC4198186?pdf=render |
| work_keys_str_mv | AT antonionouvenne comorbiditiesanddiseaseseverityasriskfactorsforcarbapenemresistantklebsiellapneumoniaecolonizationreportofanexperienceinaninternalmedicineunit AT andreaticinesi comorbiditiesanddiseaseseverityasriskfactorsforcarbapenemresistantklebsiellapneumoniaecolonizationreportofanexperienceinaninternalmedicineunit AT fulviolauretani comorbiditiesanddiseaseseverityasriskfactorsforcarbapenemresistantklebsiellapneumoniaecolonizationreportofanexperienceinaninternalmedicineunit AT marcellomaggio comorbiditiesanddiseaseseverityasriskfactorsforcarbapenemresistantklebsiellapneumoniaecolonizationreportofanexperienceinaninternalmedicineunit AT giuseppelippi comorbiditiesanddiseaseseverityasriskfactorsforcarbapenemresistantklebsiellapneumoniaecolonizationreportofanexperienceinaninternalmedicineunit AT loredanaguida comorbiditiesanddiseaseseverityasriskfactorsforcarbapenemresistantklebsiellapneumoniaecolonizationreportofanexperienceinaninternalmedicineunit AT ilariamorelli comorbiditiesanddiseaseseverityasriskfactorsforcarbapenemresistantklebsiellapneumoniaecolonizationreportofanexperienceinaninternalmedicineunit AT erminiaridolo comorbiditiesanddiseaseseverityasriskfactorsforcarbapenemresistantklebsiellapneumoniaecolonizationreportofanexperienceinaninternalmedicineunit AT lorisborghi comorbiditiesanddiseaseseverityasriskfactorsforcarbapenemresistantklebsiellapneumoniaecolonizationreportofanexperienceinaninternalmedicineunit AT tizianameschi comorbiditiesanddiseaseseverityasriskfactorsforcarbapenemresistantklebsiellapneumoniaecolonizationreportofanexperienceinaninternalmedicineunit |