PMID- 26745619
OWN - NLM
STAT- MEDLINE
DCOM- 20181025
LR  - 20181025
IS  - 1827-1596 (Electronic)
IS  - 0375-9393 (Linking)
VI  - 82
IP  - 6
DP  - 2016 Jun
TI  - Risk factors for ventilator associated pneumonia due to carbapenemase-producing 
      Klebsiella pneumoniae in mechanically ventilated patients with tracheal and 
      rectal colonization.
PG  - 635-40
AB  - BACKGROUND: The aim of this study was to identify the risk factors for ventilator 
      associated pneumonia (VAP) due to Klebsiella pneumoniae carbapenemase-producing K 
      (KPC-Kp) development in ICU patients with documented rectal and tracheal 
      colonization. METHODS: We performed a retrospective, matched case-control study 
      in a medical-surgical ICU (January 2011-December 2013) comparing 30 patients who 
      developed KPC-Kp VAP during the ICU stay to 60 colonized patients not developing 
      KPC-Kp VAP. Analysed risk factors included: age, sex, SAPS II and SOFA scores, 
      comorbidities, type and length of antibiotic therapy, previous non KPC-Kp 
      infections, time between admission to rectal and tracheal colonization. RESULTS: 
      Several risk factors were more frequent among patients who developed KPC-Kp 
      pneumonia versus matched colonized controls: previous infection not related to 
      KPC-Kp (P<0.001), duration of previous antibiotic therapy before (P<0.001) and 
      after (P=0.002) KPC-Kp colonization. Amoxicillin/clavulanic acid prophylaxis was 
      administered in 17% of VAP patients versus 73% of patients not developing VAP 
      (P<0.001). Multivariate conditional logistic regression analysis identified 
      several significant independent risk factors favoring KPC-Kp VAP in patients 
      colonized at multiple sites: previous non KPC-Kp infections (OR: 2.046), duration 
      of previous antibiotic therapy before (OR: 1.309) and after (OR: 1.122) KPC-Kp 
      colonization; antibiotic therapy with amoxicillin/clavulanic acid prophylaxis 
      (<48 hours) was associated with reduced risk of KPC-Kp VAP (OR: 0.987). 
      CONCLUSIONS: In rectal and tracheal KPC-Kp colonized patients, prolonged 
      antibiotic therapy administered for non KPC-Kp infection predisposes patients to 
      subsequent KPC-Kp VAP. Short prophylaxis of early pneumonia with 
      amoxicillin/clavulanic acid, reducing the need for subsequent antibiotic use, may 
      be associated with reduced risk for KPC-Kp VAP.
FAU - Sbrana, Francesco
AU  - Sbrana F
AD  - U.O. Lipidoaferesi, Fondazione Toscana Gabriele Monasterio, Pisa, Italy - 
      francesco.sbrana@ftgm.it.
FAU - Malacarne, Paolo
AU  - Malacarne P
FAU - Bassetti, Matteo
AU  - Bassetti M
FAU - Tascini, Carlo
AU  - Tascini C
FAU - Vegnuti, Lara
AU  - Vegnuti L
FAU - Della Siega, Paola
AU  - Della Siega P
FAU - Ripoli, Andrea
AU  - Ripoli A
FAU - Ansaldi, Filippo
AU  - Ansaldi F
FAU - Menichetti, Francesco
AU  - Menichetti F
LA  - eng
PT  - Journal Article
DEP - 20160108
PL  - Italy
TA  - Minerva Anestesiol
JT  - Minerva anestesiologica
JID - 0375272
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Bacterial Proteins)
RN  - EC 3.5.2.6 (beta-Lactamases)
RN  - EC 3.5.2.6 (carbapenemase)
SB  - IM
CIN - Minerva Anestesiol. 2016 Jun;82(6):616-8. PMID: 27029825
MH  - Anti-Bacterial Agents/therapeutic use
MH  - Bacterial Proteins/*biosynthesis
MH  - Carrier State/microbiology
MH  - Case-Control Studies
MH  - Female
MH  - Humans
MH  - Klebsiella Infections/*microbiology/prevention & control
MH  - Klebsiella pneumoniae/*enzymology
MH  - Male
MH  - Middle Aged
MH  - Pneumonia, Ventilator-Associated/*microbiology/prevention & control
MH  - Rectum/*microbiology
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Trachea/*microbiology
MH  - beta-Lactamases/*biosynthesis
EDAT- 2016/01/09 06:00
MHDA- 2018/10/26 06:00
CRDT- 2016/01/09 06:00
PHST- 2016/01/09 06:00 [entrez]
PHST- 2016/01/09 06:00 [pubmed]
PHST- 2018/10/26 06:00 [medline]
AID - R02Y9999N00A160005 [pii]
PST - ppublish
SO  - Minerva Anestesiol. 2016 Jun;82(6):635-40. Epub 2016 Jan 8.