Risk factors for carbapenem-resistant Klebsiella pneumoniae infections in Intensive Care Units: a multicentre case-control study with a competing-risks analysis.

Ferhat Arslan, Ece Akbulut, Seniha Senbayrak, Asu Özgültekin, Sebahat Aksaray, Hayriye Cankar Dal, Hasan Oktay Emir, Handan Ankarali, Ali Mert, Haluk Vahaboglu
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Abstract

Aim: This study investigated the risk factors for the development of carbapenem-resistant Klebsiella pneumoniae (CRKP) infections in adult patients in Intensive Care Units (ICUs).

Methods: A multicentre case-control study was conducted in ICUs in three tertiary hospitals in Turkey. The cases were patients culture-confirmed CRKP and a condition associated with healthcare-associated infections. Two controls were randomly selected for each case from among all other patients with an ICU stay at least as long as that of the corresponding case-patient. A proportional semiparametric subdistribution hazards regression model was used to assess risk factors for CRKP infection. ICU discharge and non-CRKP-related deaths were treated as competing risks.

Results: A total of 120 patients, 44 cases and 76 controls were included in the analysis. Of the controls, 32 were discharged from the ICU and 44 died without acquiring CRKP infection. Endotracheal intubation (hazard ratio [HR]: 1.96, 95% confidence interval [CI]: 1.00-3.868) and type 2 diabetes mellitus (HR: 1.57, 95% CI: 0.888-2.806) were associated with an increased risk of CRKP infection, whereas carbapenem exposure (HR: 0.47, 95% CI: 0.190-1.1175) and the presence of a nasogastric tube (HR: 0.49, 95% CI: 0.277-0.884) were associated with a decreased risk of CRKP infection.

Conclusions: Enteral nutrition support via a nasogastric tube may be associated with a reduced risk of CRKP-resistant infections in ICU patients. This hypothesis should be tested with a well-designed study.

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重症监护病房耐碳青霉烯类肺炎克雷伯氏菌感染的风险因素:一项采用竞争风险分析的多中心病例对照研究。
目的:本研究调查了重症监护病房(ICU)中成年患者发生耐碳青霉烯类肺炎克雷伯菌(CRKP)感染的风险因素:在土耳其三家三级医院的重症监护病房开展了一项多中心病例对照研究。病例为经培养确诊的 CRKP 患者以及与医疗相关感染有关的病症。每个病例的两名对照组均从所有其他患者中随机抽取,这些患者在重症监护室的住院时间至少与相应病例的住院时间相同。采用比例半参数子分布危害回归模型评估CRKP感染的风险因素。ICU出院和非CRKP相关死亡被视为竞争风险:共有120名患者(44例病例和76例对照)被纳入分析。在对照组中,有 32 人从重症监护室出院,44 人死亡,但未感染 CRKP。气管插管(危险比 [HR]:1.96,95% 置信区间 [CI]:1.00-3.868)和 2 型糖尿病(HR:1.57,95% CI:0.888-2.806)与 CRKP 感染风险增加有关,而碳青霉烯暴露(HR:0.47,95% CI:0.190-1.1175)和鼻胃管的存在(HR:0.49,95% CI:0.277-0.884)与CRKP感染风险的降低有关:结论:通过鼻胃管进行肠内营养支持可能与 ICU 患者耐 CRKP 感染风险的降低有关。这一假设应通过精心设计的研究加以验证。
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