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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 3

Association between delay in receiving adequate antimicrobial therapy after KPC-Kp isolation and selected patient characteristics, Italy*

Characteristics Delay from KPC-Kp isolation to adequate antimicrobial therapy
 χ2 p value p value†
<4 d >4 d
All 190 (63.9) 107 (36.0) NA NA
Age, median (IQR) 68.5 (62–78) 74 (63–81) 0.151 0.285
Charlson Index, median (IQR)
 5.0 (4–8)
 6.0 (4–8)
 0.615
 0.439
Intensive care unit admission
Y 41 (63.1) 24 (36.9) 0.865 0.354
N
 149 (64.2)
 83 (35.8)
Previous KPC-Kp colonization during the current hospitalization
Y 46 (74.2) 16 (25.8) 0.060 0.118
N
 144 (61.3)
 91 (38.7)
KPC-Kp colonization in the previous 12 mo
Y 104 (77.0) 31 (23.0) <0.001
 <0.001
N
 86 (53.2)
 75 (46.8)
Hospitalization in the previous 12 mo
Y 149 (64.5) 82 (35.5) 0.832
 0.779
N
 41 (63.1)
 24 (36.9)
Antimicrobial therapy in the 30 d before hospitalization
Y 145 (64.0) 84 (36.0) 0.564
 0.627
N
 45 (67.2)
 22 (32.8)
Major surgery‡
Y 48 (53.9) 41 (46.1) 0.018 0.008
N 142 (74.7) 66 (31.7)
KPC-Kp infection severity§
Severe 139 (71.5) 55 (28.3) 0.0002 <0.001
Mild 52 (50.0) 52 (50.0)

*Values are no. (%) except as indicated. Delay determined according to infected patients’ resistance profiles; 33 patients were excluded: 17 had follow-up <3 days after isolation and 16 had no data on empirical therapies. IQR, interquartile range; KPC-Kp, Klebsiella pneumoniae-carbapenemase producing Klebsiella pneumoniae; NA, not applicable. †Obtained from multivariable mixed logistic model adjusted by center, as random effect; age; and type of KPC-Kp infection, when appropriate. ‡Major surgery includes any invasive operative procedure in which a more extensive resection is performed, including a body cavity is entered, organs are removed, or normal anatomy is altered.§Severe infection included bloodstream or lower respiratory tract infection plus septic shock from other sites; Mild infection included infections from other sites; and colonized patients were identified through surveillance protocols.

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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