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Volume 27, Number 5—May 2021
CME ACTIVITY - Research

Characteristics and Clinical Implications of Carbapenemase-Producing Klebsiella pneumoniae Colonization and Infection, Italy

Marianna Rossi, Liliane Chatenoud, Floriana Gona, Isabella Sala, Giovanni Nattino, Alessia D'Antonio, Daniele Castelli, Teresa Itri, Paola Morelli, Sara Bigoni, Chiara Aldieri, Roberto Martegani, Paolo A. Grossi, Cecilia Del Curto, Stefania Piconi, Sara G. Rimoldi, Paola Brambilla, Paolo Bonfanti, Evelyn Van Hauwermeiren, Massimo Puoti, Gianni Gattuso, Chiara Cerri, Mario C. Raviglione, Daniela M. Cirillo, Alessandra Bandera, Andrea GoriComments to Author , and The KPC-Kp Study Group1
Author affiliations: S. Gerardo Hospital, Monza, Italy (M. Rossi, T. Itri, D. Castelli, P. Bonfanti); Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy (L. Chatenoud, I. Sala, G. Nattino, A. D’Antonio); IRCCS San Raffaele Scientific Institute, Milan (F. Gona, C. Del Curto, D.M. Cirillo); Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan (T. Itri, A. Bandera, A. Gori); Humanitas University, Milan (P. Morelli); Papa Giovanni XXIII Hospital, Bergamo, Italy (S. Bigoni); University of Milan San Paolo Hospital, Milan (C. Aldieri); Busto Arsizio Hospital, Busto Arsizio, Italy (R. Martegani); University of Insubria, ASST Sette Laghi-Varese, Italy (P.A. Grossi); ASST Fatebenefratelli Sacco, Milan (S. Piconi, S.G. Rimoldi); Clinic of Infectious Diseases of Istituti Ospedalieri of Cremona, Cremona, Italy (P. Brambilla); University of Milan-Bicocca, Milan (P. Bonfanti); University of Brescia and ASST Spedali Civili, Brescia, Italy (E. Van Hauwermeiren); ASST Grande Ospedale Metropolitano Niguarda, Milan (M. Puoti); Carlo Poma Hospital, Mantova, Italy (G. Gattuso); Hospital of Lodi, Lodi, Italy (C. Cerri); University of Milan, Milan (M.C. Raviglione, A. Bandera, A. Gori)

Main Article

Table 2

In-hospital death within 15 days of KPC-Kp isolation in a cohort of infected patients and subgroup of patients with bloodstream infections, Italy*

KPC-Kp infections No. Died, no. (%) HR (95% CI)† p value HR (95% CI)‡ p value
All patients
 1,039
 174 (16.7)
 NA
 NA
 NA
 NA
Severity of infection§
Colonized 712 100 (14.0) Referent NA Referent NA
Mild 109 13 (11.9) 0.71 (0.40–1.27) 0.247 0.75 (0.42–1.34) 0.328
Severe
 218
 61 (28.0)
 1.84 (1.34–2.54)
 0.0002
 1.93 (1.40–2.66)
 <0.0001
Bloodstream infections 176 45 (25.6) NA NA NA NA
Septic shock at admission
N 132 25 (18.9) Referent NA Referent NA
Y 44 20 (45.5) 2.72 (1.50–4.90) 0.0009 2.71 (1.46–5.02) 0.002

*All patients are stratified for severity of infection; the subgroup of patients with bloodstream infection is stratified for septic shock. KPC-Kp, Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae; NA, not applicable. †Hazard ratio (HR) estimates are from multivariable Cox proportional hazard models, adjusting for center (random effect) and days elapsing from hospitalization to KPC-Kp isolation. ‡Multivariate Cox mixed effects model adjusting for center (random effect) and days elapsing from hospitalization to KPC-Kp isolation, age, Charlson Index, and whether or not isolates were collected when patient was in the intensive care unit. §Patients discharged or deceased on the day of KPC-Kp isolation were excluded from analyses; 20 patients were discharged, 9 colonized patients died, and 3 colonized patients had severe infections.

Main Article

1Group collaborators are listed at the end of this article.

Page created: March 05, 2021
Page updated: April 22, 2021
Page reviewed: April 22, 2021
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