Format

Send to

Choose Destination
Infect Control Hosp Epidemiol. 2015 Aug;36(8):942-8. doi: 10.1017/ice.2015.118. Epub 2015 May 20.

Residence in Skilled Nursing Facilities Is Associated with Tigecycline Nonsusceptibility in Carbapenem-Resistant Klebsiella pneumoniae.

Author information

1
1Division of Infectious Diseases,University of North Carolina,Chapel Hill,North Carolina.
2
2Department of Infectious Diseases,Cleveland Clinic,Cleveland,Ohio.
3
3Department of Laboratory Medicine,Cleveland Clinic,Cleveland,Ohio.
4
4Research Service,Louis Stokes Cleveland Department of Veterans Affairs Medical Center,Cleveland,Ohio.
5
6Department of Medicine,MetroHealth Medical Center,Cleveland,Ohio.
6
5Division of Infectious Diseases and HIV Medicine,Department of Medicine,Case Western Reserve University School of Medicine,Cleveland,Ohio.
7
7Department of Biostatistics and the Center for Biostatistics in AIDS Research,Harvard School of Public Health,Boston,Massachusetts.
8
8Division of Infectious Diseases,Duke University,Durham,North Carolina.
9
11Division of Infectious Diseases,Detroit Medical Center,Wayne State University,Detroit,Michigan.

Abstract

OBJECTIVE:

To determine the rates of and risk factors for tigecycline nonsusceptibility among carbapenem-resistant Klebsiella pneumoniae (CRKPs) isolated from hospitalized patients.

DESIGN:

Multicenter prospective observational study.

SETTING:

Acute care hospitals participating in the Consortium on Resistance against Carbapenems in Klebsiella pneumoniae (CRaCKle).

PATIENTS:

A cohort of 287 patients who had CRKPs isolated from clinical cultures during hospitalization.

METHODS:

For the period from December 24, 2011 to October 1, 2013, the first hospitalization of each patient with a CRKP during which tigecycline susceptibility for the CRKP isolate was determined was included. Clinical data were entered into a centralized database, including data regarding pre-hospital origin. Breakpoints established by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) were used to interpret tigecycline susceptibility testing.

RESULTS:

Of 287 patients included in the final cohort, 155 (54%) had tigecycline-susceptible CRKPs. Of all index isolates, 81 (28%) were tigecycline-intermediate and 51 (18%) were tigecycline resistant. In multivariate modeling, independent risk factors for tigecycline nonsusceptibility were (1) admission from a skilled nursing facility (OR, 2.51; 95% CI, 1.51-4.21; P=.0004), (2) positive culture within 2 days of admission (OR, 1.82; 95% CI, 1.06-3.15; P=.03), and (3) receipt of tigecycline within 14 days (OR, 4.38, 95% CI, 1.37-17.01, P=.02).

CONCLUSIONS:

In hospitalized patients with CRKPs, tigecycline nonsusceptibility was more frequently observed in those admitted from skilled nursing facilities and occurred earlier during hospitalization. Skilled nursing facilities are an important target for interventions to decrease antibacterial resistance to antibiotics of last resort for treatment of CRKPs.

PMID:
25990806
PMCID:
PMC4642723
DOI:
10.1017/ice.2015.118
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Cambridge University Press Icon for PubMed Central
Loading ...
Support Center