Risk Factors for Subsequential Carbapenem-Resistant Klebsiella pneumoniae Clinical Infection Among Rectal Carriers with Carbapenem-Resistant Klebsiella pneumoniae

Figures & data

Table 1 Antimicrobial Resistance of Rectal Carbapenem-Resistant Klebsiella pneumoniae Isolates

Antimicrobial Agents	No.(%) of Resistant Isolates		P
	Case Group(n=23)	Control Group(n=39)
Meropenem	23 (100)	38 (97.4)	0.788
Imipenem	23 (100)	36 (92.3)	0.045
Ertapenem	23 (100)	38 (97.4)	0.788
Ampicillin-sulbactam	23 (100)	38 (97.4)	0.788
Piperacillin-tazobactam	23 (100)	36 (92.3)	0.045
Cefazolin	23 (100)	38 (97.4)	0.788
Cefuroxime	23 (100)	38 (97.4)	0.788
Ceftriaxone	23 (100)	38 (97.4)	0.788
Ceftazidime	23 (100)	38 (97.4)	0.788
Cefepime	23 (100)	38 (97.4)	0.788
Cefotetan	23 (100)	38 (97.4)	0.788
Aztreonam	23 (100)	37 (94.8)	0.719
Ciprofloxacin	23 (100)	32 (82.0)	0.082
Levofloxacin	23 (100)	31 (79.5)	0.053
Gentamicin	18 (78.3)	34 (87.2)	0.572
Tobramycin	18 (78.3)	31 (79.5)	0.835
Amikacin	18 (78.3)	26 (66.7)	0.331
Trimethoprim-sulfamethoxazole	9 (39.1)	8 (20.5)	0.112
Tigecycline	4 (17.4)	9 (23.1)	0.835

Note: Values are presented as number (%).

Table 2 Carbapenemase Genes Detected in Rectal Carbapenem-Resistant Klebsiella pneumoniae Isolates

Carbapenemase Genes	Case Group (n=23)	Control Group^a (n=39)	P
KPC	21(91.3)	35(89.7)	0.788
KPC+NDM^b	1(4.3)	2(5.1)	0.635
KPC+IMP^c	1(4.3)	1(2.6)	0.719
VIM	–	–	–
OXA-48	–	–	–

Notes: Values are presented as number (%). ^aOne carbapenem-resistant Klebsiella pneumoniae isolate did not detect any of the tested carbapenemase genes. ^bCarbapenem-resistant Klebsiella pneumoniae isolates co-produce both KPC and NDM genes. ^cCarbapenem-resistant Klebsiella pneumoniae isolates co-produce both KPC and IMP genes.

Abbreviations: KPC, Klebsiella pneumoniae carbapenemase; NDM, New Delhi metallo-β-lactamases; IMP, imipenem-hydrolyzing metallo-β-lactamases; VIM, Verona integron-encoded metallo-β-lactamases; OXA, oxacillin-hydrolyzing metallo-β-lactamases.

Table 3 Univariate Analysis of Risk Factors Associated with Subsequential CRKP Clinical Infection Among CRKP Rectal Carriers

Variables	Case Group (n=23)	Control Group(n=39)	Univariate Analysis
			OR	95% CI	P
Demographics
Male sex, n(%)	17 (73.9)	33 (84.6)	0.515	0.144–1.842	0.303
Median age (range), years	55 (22–81)	42 (0–84)	–	–	0.039*
Age≤65 years, n(%)	9 (39.1)	10 (25.6)	0.141	0.129–1.106	0.266
Length of stay (days), IQR (range)	45 (14–84)	18 (5–57)	–	–	0.026*
Previous hospitalization, n(%)	6 (26.1)	13 (33.3)	0.706	0.225–2.217	0.550
History of smoking, n(%)	3 (13.0)	13 (33.3)	0.300	0.075–1.197	0.132
History of alcohol, n(%)	3 (13.0)	9 (23.1)	0.500	0.120–2.077	0.508
Admission to ICU, n(%)	18 (78.3)	15 (38.5)	5.760	1.766–18.789	0.002*
Transfer from another hospital, n(%)	5 (21.7)	9 (23.1)	0.926	0.268–3.198	1.000
Sickbed change, n(%)	11 (47.8)	15 (38.5)	1.467	0.517–4.157	0.470
Comorbid Conditions, n(%)
Solid tumor	2 (8.7)	5 (12.8)	0.648	0.115–3.645	1.000
Hypertension	8 (34.8)	13 (33.3)	1.067	0.360–3.160	0.907
Heart disease	5 (21.7)	7 (17.9)	1.270	0.351–4.589	0.748
Diabetes mellitus	1 (4.3)	6 (15.4)	0.250	0.028–2.222	0.243
Hematopathy	0 (0)	5 (12.8)	0.872	0.773–0.983	0.148
Lung disease	12 (52.2)	15 (39.5)	1.673	0.588–4.757	0.333
Renal disease	6 (26.1)	5 (12.8)	2.400	0.640–9.002	0.302
Liver disease	6 (26.1)	7 (17.9)	1.613	0.467–5.570	0.447
Pancreatitis	3 (13.0)	6 (15.4)	0.825	0.185–3.672	1.000
Enteritis	3 (13.0)	2 (5.1)	2.775	0.428–18.006	0.350
Gastritis	12 (52.2)	7 (17.9)	4.987	1.568–15.857	0.005*
Craniocerebral trauma	1 (4.3)	2 (5.1)	0.841	0.072–9.821	1.000
Invasive Procedures, n(%)
Arterial catheter	8 (34.8)	6 (15.4)	2.933	0.86–9.954	0.078
Central venous catheter	15 (65.2)	12 (30.8)	4.219	1.412–12.609	0.008*
Endotracheal intubation	11 (47.8)	10 (25.6)	2.658	0.895–7.899	0.075
Tracheotomy	9 (39.1)	9 (23.1)	2.143	0.699–6.573	0.179
Mechanical ventilation	16 (69.6)	16 (41.0)	3.286	1.101–9.808	0.030*
Urinary catheter	16 (69.6)	19 (48.7)	2.406	0.811–7.140	0.110
Nasogastric tube	13 (56.5)	19 (48.7)	1.368	0.485–3.857	0.553
Other Clinical Parameters
Previous surgery
In a month	6 (26.1)	14 (35.9)	0.630	0.202–1.966	0.425
In three months	11 (47.8)	14 (35.9)	1.637	0.574–4.666	0.355
Being in coma condition (GCS score≤8)	7 (30.4)	3 (7.7)	5.250	1.201–22.951	0.019*
Antimicrobial Exposure, n(%)
Penicillin	0 (0)	4 (10.3)	0.897	0.807–0.998	0.287
Cephalosporins	7 (30.4)	14 (35.9)	0.781	0.259–2.354	0.661
Carbapenems	16 (69.6)	16 (41.0)	3.286	1.101–9.808	0.030*
Aminoglycosides	4 (17.4)	2 (5.1)	3.895	0.653–23.217	0.183
Fluoroquinolones	9 (39.1)	10 (25.6)	1.864	0.618–5.621	0.266
β-lactam/β-lactamase inhibitors	14 (60.9)	19 (48.7)	1.637	0.575–4.664	0.354
Antifungal agents	10 (43.5)	11 (28.2)	1.958	0.665–5.765	0.220
Other antibiotics
Vancomycin	9 (39.1)	10 (25.6)	1.864	0.618–5.621	0.266
Tigecycline	6 (26.1)	1 (2.6)	13.412	1.497–120.184	0.005*
Metronidazole	1 (4.3)	2 (5.1)	0.814	0.072–9.821	1.000
The use of antibiotics ≥3, n(%)	10 (43.5)	14 (35.9)	1.374	0.479–3.935	0.554

Note: *P<0.05.

Abbreviations: OR, odds ratio; CI, confidence interval; IQR, interquartile range.

Table 4 Multivariate Analysis of Risk Factors Associated with Subsequential CRKP Clinical Infection Among CRKP Rectal Carriers

Variables	OR (95% CI)	P
Admission to ICU	6.753 (1.732–26.327)	0.006
Being in coma condition (GCS score ≤8)	11.085 (1.588–77.386)	0.015
Central venous catheter	8.628 (2.033–36.624)	0.003

Abbreviations: OR, odds ratio; CI, confidence interval.