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Open Forum Infect Dis. 2017 Oct 6;4(4):ofx216. doi: 10.1093/ofid/ofx216. eCollection 2017 Fall.

Carbapenem-Resistant Enterobacteriaceae Infections in Patients on Renal Replacement Therapy.

Author information

1
Department of Medicine, SUNY Downstate Medical Center, New York, New York.
2
Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio.
3
Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio.
4
Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio.
5
Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio.
6
Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio.
7
Department of Internal Medicine, Northeast Ohio Medical University, Rootstown, Ohio.
8
Division of Infectious Diseases, Akron General Medical Center, Akron, Ohio.
9
Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
10
Division of Infectious Diseases, University of Michigan, Ann Arbor, Michigan.
11
Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts.
12
Division of Infectious Diseases, Duke University, Durham, North Carolina.
13
Duke Clinical Research Institute, Duke University, Durham, North Carolina.
14
Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio.
15
Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio.
16
Public Health Research Institute Center, New Jersey Medical School-Rutgers, Newark, New Jersey.
17
Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina.

Abstract

Background:

Patients on chronic intermittent renal replacement therapy (RRT) are at risk for infection with carbapenem-resistant Enterobacteriaceae (CRE). However, the impact of RRT on outcomes after CRE infections remains to be defined. Here we perform a comparison of outcomes for CRE-infected patients with preserved renal function compared with CRE-infected patients on RRT.

Methods:

Cases and controls were defined from a prospective cohort of CRE-infected patients from the Consortium on Resistance against Carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE). Cases were defined as CRE-infected patients on RRT at hospital admission, while controls were defined as CRE-infected patients with serum creatinine <2 mg/dL and not receiving RRT at admission. Risk factors for 28-day in-hospital mortality were assessed using multivariable logistic regression. An ordinal ranking of outcomes by desirability analysis was performed.

Results:

Patients on RRT were more likely to have diabetes mellitus and cardiac disease than controls. Urinary sources of infection were less common in the RRT group. In RRT patients, 28-day in-hospital mortality was increased as compared with controls: 22/71 (31%) vs 33/295 (11%). RRT remained significantly associated with 28-day in-hospital mortality after adjustment for source of infection, prehospitalization origin, and severity of illness (adjusted odds ratio, 2.27; 95% confidence interval [CI], 1.09-4.68; P = .03). Using univariable desirability of outcome ranking analysis, RRT status was associated with a 68% (95% CI, 61%-74%) chance of a worse disposition outcome.

Conclusions:

Chronic RRT in CRE-infected patients is associated with increased in-hospital mortality and worse disposition outcomes at 28 days.

KEYWORDS:

Klebsiella pneumoniae; carbapenem-resistant Enterobacteriaceae; mortality; renal failure; renal replacement therapy

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