Carbapenem-Resistant Enterobacteriaceae Infections in Patients on Renal Replacement Therapy
نویسندگان
چکیده
Background Patients on chronic intermittent renal replacement therapy (RRT) are at risk for infection with carbapenem-resistant Enterobacteriaceae (CRE). However, the impact of RRT on outcomes after CRE infections remains to be defined. Here we perform a comparison of outcomes for CRE-infected patients with preserved renal function compared with CRE-infected patients on RRT. Methods Cases and controls were defined from a prospective cohort of CRE-infected patients from the Consortium on Resistance against Carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE). Cases were defined as CRE-infected patients on RRT at hospital admission, while controls were defined as CRE-infected patients with serum creatinine <2 mg/dL and not receiving RRT at admission. Risk factors for 28-day in-hospital mortality were assessed using multivariable logistic regression. An ordinal ranking of outcomes by desirability analysis was performed. Results Patients on RRT were more likely to have diabetes mellitus and cardiac disease than controls. Urinary sources of infection were less common in the RRT group. In RRT patients, 28-day in-hospital mortality was increased as compared with controls: 22/71 (31%) vs 33/295 (11%). RRT remained significantly associated with 28-day in-hospital mortality after adjustment for source of infection, prehospitalization origin, and severity of illness (adjusted odds ratio, 2.27; 95% confidence interval [CI], 1.09-4.68; P = .03). Using univariable desirability of outcome ranking analysis, RRT status was associated with a 68% (95% CI, 61%-74%) chance of a worse disposition outcome. Conclusions Chronic RRT in CRE-infected patients is associated with increased in-hospital mortality and worse disposition outcomes at 28 days.
منابع مشابه
Evaluation and Identification of Carbapenem Resistant Klebsiella pneumoniae Isolated from Hospitalized Patients in Qom City, (Iran)
Background and Objectives: Klebsiella pneumonia is a facultative anaerobe bacterium from enterobacteriaceae family, which causes a wide range of diseases, such as urinary tract infections, cystitis, pneumonia, surgical wounds infections, infectious endocarditis, and diffused infections, especially in patients with HIV infection and immunosuppression. The aim of this study was to identify carbap...
متن کاملInfections due to Carbapenem Resistant Enterobacteriaceae among Saudi Arabian Hospitalized Patients: A Matched Case-Control Study
Background. We conducted this case-control study to determine the risk factors and treatment outcome of infections due to carbapenem resistant Enterobacteriaceae in our institution. Methods. This is a matched case-control study of patients with infection due to carbapenem resistant Enterobacteriaceae (CRE) and carbapenem susceptible Enterobacteriaceae (CSE), from Riyadh, Saudi Arabia, between M...
متن کاملAntibacterial and Antibiofilm Activity of Grape Seed Extract Against Carbapenem Resistant and Biofilm Producer Enterobacteriaceae
Background and objectives: Carbapenem-resistant and biofilm producing Enterobacteriaceaeare a major health problem. This study was carried to determine the antibacterial and antibiofilm activity of grape seed extract (GSE) against carbapenem-resistant and biofilm producing Enterobacteriaceae isolates. Methods: Antibiotics susceptibility pattern...
متن کاملTreatment Options for Carbapenem-Resistant Enterobacteriaceae Infections
This article provides a comprehensive review of currently available treatment options for infections due to carbapenem-resistant Enterobacteriaceae (CRE). Antimicrobial resistance in Gram-negative bacteria is an emerging and serious global public health threat. Carbapenems have been used as the "last-line" treatment for infections caused by resistant Enterobacteriaceae, including those producin...
متن کاملSevere Bloodstream Infection due to KPC-Producer E coli in a Renal Transplant Recipient Treated With the Double-Carbapenem Regimen and Analysis of In Vitro Synergy Testing
Transplant recipients are at high risk of infections caused by multidrug resistant microorganisms. Due to the limited therapeutic options, innovative antimicrobial combinations against carbapenem-resistant Enterobacteriaceae causing severe infections are necessary.A 61-year-old woman with a history of congenital solitary kidney underwent renal transplantation. The postoperative course was compl...
متن کامل