Carbapenem-resistant Klebsiella pneumoniae is associated with poor outcome in hemodialysis patients

Dina Bleumin, Matan J. Cohen*, Olivier Moranne, Vincent L.M. Esnault, Shmuel Benenson, Ora Paltiel, Keren Tzukert, Irit Mor-Yosef Levi, Iddo Z. Ben-Dov, Ronen Levi, Aharon Bloch, Yosef S. Haviv

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

Abstract

Background: Hemodialysis (HD) units have become a source of resistant bacteria. One of the most alarming developments is the emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP). Risk factors and outcomes of CRKP isolation in HD patients have not been previously studied. Methods: A nested case-control study was conducted in maintenance HD patients between January 1st 2006 and June 30th 2009. CRKP-positive patients were matched with randomly selected CRKP-negative HD patients. Demographics, clinical and laboratory data were collected for 24 months prior to the specimen collection. Multivariate analyses identified independent risk factors for CRKP. A prospective follow-up determined CRKP-associated outcome. Results: Demographics associated with CRKP acquisition in HD patients were age between 65 and 75 and having no living offspring. Clinical conditions associated with CRKP were previous hospitalization, temporary HD catheter and previous isolation of vancomycin-resistant enterococcus. CRKP-related outcome was poor: median survival of one month and a hazard ratio [95% CI] of 5.9 [3.2-11.0] for mortality. Conclusions: Temporary HD catheters and previous treatment for VRE may predict subsequent CRKP isolation. A microbiological diagnosis of CRKP in HD patients is highly associated with imminent mortality. Meticulous measures to control the spread of CRKP bacteria among HD patients appear particularly warranted.

Original languageAmerican English
Pages (from-to)318-325
Number of pages8
JournalJournal of Infection
Volume65
Issue number4
DOIs
StatePublished - Oct 2012
Externally publishedYes

Bibliographical note

Funding Information:
This work was conducted as part of the requirements of the Hebrew University School of Public Health for an MPH degree (D.B.) and partially supported by non-restrictive grants from Teva Medical Israel , Janssen-Cilag Israel and Roche Israel . The authors had complete autonomy in regard to the design, analysis and publication of this study. Data Analyses for this study were facilitated by an epidemiologic research collaboration between the Departments of Nephrology at the CHU de Nice Hôpital Pasteur and Hadassah-Hebrew University Medical Center, Jerusalem.

Keywords

  • Hemodialysis
  • Klebsiella pneumoniae carbapenemase
  • Multi-drug resistance

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