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Comparison of clinical outcomes of patients infected with KPC- and NDM-producing Enterobacterales: a retrospective cohort study.
- Source :
-
Clinical Microbiology & Infection . Aug2021, Vol. 27 Issue 8, p1167.e1-1167.e8. 1p. - Publication Year :
- 2021
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Abstract
- We aimed to compare clinical outcomes of patients with Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacterales and those with New Delhi metallo-β-lactamase (NDM)-producing Enterobacterales. We performed a retrospective cohort study of all adult patients with KPC- or NDM-producing Enterobacterales isolates in a 2700-bed tertiary referral hospital in Seoul, South Korea, between 2010 and 2019. The primary outcome was 30-day mortality after first isolation of KPC- or NDM-producing Enterobacterales. The secondary outcome was the development of infection within 30 days by the colonizing isolates, among colonized patients. We performed Cox regression analysis for 30-day mortality and competing risk analysis for development of infection. A total of 859 patients were identified during the study period; 475 (55%) had KPC and 384 (45%) had NDM. Thirty-day mortality was significantly higher in the KPC group than in the NDM group (17% (81/475) vs 9% (33/384); p < 0.001). The KPC group developed infection within 30 days from the initial colonization after first isolation more frequently than the NDM group (8% (27/353) vs. 3% (10/295); p 0.02). Multivariable analysis revealed that independent risk factors for 30-day mortality were solid cancer (adjusted hazard ratio (aHR) 2.51; 95% confidence interval (CI) 1.66–3.79; p < 0.001), solid organ transplant (aHR 0.32; 95% CI 0.17–0.61; p < 0.001), a high APACHE II score (aHR 1.11; 95% CI 1.08–1.13; p < 0.001), KPC-producing Enterobacterales (aHR 1.69; 95% CI 1.02–2.79; p 0.04), previous carbapenem use within 3 months (aHR 1.86; 95% CI 1.26–2.75; p < 0.001) and site of KPC- or NDM-producing Enterobacterales infection at the time of the first culture (p < 0.001). Our study suggests that KPC-producing Enterobacterales is significantly associated with poorer outcomes than NDM-producing Enterobacterales. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 1198743X
- Volume :
- 27
- Issue :
- 8
- Database :
- Academic Search Index
- Journal :
- Clinical Microbiology & Infection
- Publication Type :
- Academic Journal
- Accession number :
- 151758459
- Full Text :
- https://doi.org/10.1016/j.cmi.2020.09.043