Risk factors for carbapenem-resistant klebsiella pneumoniae hospital infection in the intensive care unit

Abstract

Carbapenem-resistant Klebsiella pneumoniae (CR-Kp) has become a major threat to patients in hospitals, increasing mortality, length of stay and costs. The aim of this study was to discover risk factors for the development of hospital infections (HIs) caused by CR-Kp. A prospective cohort study was conducted in the Med-ical-Surgical Intensive Care Unit of the Clinical Centre in Kragujevac, Kragujevac, Serbia, from January 1, 2011, to December 31, 2015. The “cases” were patients with HIs caused by CR-Kp, while the “controls” were patients infected with carbapenem-sensitive Klebsiella pneumoniae (CS-Kp). The significance of multiple putative risk factors for HIs caused by CR-Kp was tested using multivariate logistic regression. Although univariate analyses pointed to many risk factors, with a significant influence on the occurrence of hospital CR-Kp infections, the multivariate logistic regression identified five independent risk factors: use of mechanical ventilation (OR=6.090; 95% CI=1.030-36.020; p=0.046); length of antibiotic therapy before HIs (days) (OR=1.080; 95% CI=1.003-1.387; p=0.045); previous use of carbapenems (OR=7.005; 95% CI=1.054-46.572; p=0.044); previous use of ciprofloxacin (OR=20.628; 95% CI=2.292-185.687; p=0.007) and previous use of metronidazole (OR=40.320; 95% CI=2.347-692.795; p=0.011) HIs caused by CR-Kp are strongly associated with the use of mechanical ventilation and the duration of the previous use of certain antibiotics (carbapenems, ciprofloxacin and metronidazole).