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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.
J Hosp Infect. 2015 Feb; 89(2):123-31.JH

Abstract

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.

Authors+Show Affiliations

Internal Medicine Service, Hospital La Merced, Osuna, Seville, Spain. Electronic address: vergara_lopez@hotmail.com.Laboratory of Microbiology, Hospital La Merced, Osuna, Seville, Spain.Department of Microbiology, University of Seville, Seville, Spain.Department of Microbiology, University of Seville, Seville, Spain; Infectious Diseases and Clinical Microbiology Unit, University Hospital Virgen Macarena, Seville, Spain.Infectious Diseases and Clinical Microbiology Unit, University Hospital Virgen Macarena, Seville, Spain; Department of Medicine, University of Seville, Seville, Spain.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25595832

Citation

Vergara-López, S, et al. "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." The Journal of Hospital Infection, vol. 89, no. 2, 2015, pp. 123-31.
Vergara-López S, Domínguez MC, Conejo MC, et al. 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. J Hosp Infect. 2015;89(2):123-31.
Vergara-López, S., Domínguez, M. C., Conejo, M. C., Pascual, Á., & Rodríguez-Baño, J. (2015). 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. The Journal of Hospital Infection, 89(2), 123-31. https://doi.org/10.1016/j.jhin.2013.12.008
Vergara-López S, et al. 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. J Hosp Infect. 2015;89(2):123-31. PubMed PMID: 25595832.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Vergara-López,S, AU - Domínguez,M C, AU - Conejo,M C, AU - Pascual,Á, AU - Rodríguez-Baño,J, Y1 - 2014/01/15/ PY - 2013/09/03/received PY - 2013/12/30/accepted PY - 2015/1/18/entrez PY - 2015/1/18/pubmed PY - 2015/8/28/medline KW - Carbapenem-resistant Enterobacteriaceae KW - Klebsiella oxytoca KW - Outbreak KW - Time at risk SP - 123 EP - 31 JF - The Journal of hospital infection JO - J. Hosp. Infect. VL - 89 IS - 2 N2 - 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. SN - 1532-2939 UR - https://www.unboundmedicine.com/medline/citation/25595832/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_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0195-6701(14)00020-6 DB - PRIME DP - Unbound Medicine ER -