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

Published online by Cambridge University Press:  20 May 2015

David van Duin ,
Eric Cober ,
Sandra S. Richter ,
Federico Perez ,
Robert C. Kalayjian ,
Robert A. Salata ,
Scott Evans ,
Vance G. Fowler Jr. ,
Robert A. Bonomo  and
Keith S. Kaye
David van Duin*
Affiliation:
Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
Eric Cober
Affiliation:
Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
Sandra S. Richter
Affiliation:
Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
Federico Perez
Affiliation:
Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
Robert C. Kalayjian
Affiliation:
Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio
Robert A. Salata
Affiliation:
Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
Scott Evans
Affiliation:
Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
Vance G. Fowler Jr.
Affiliation:
Division of Infectious Diseases, Duke University, Durham, North Carolina
Robert A. Bonomo
Affiliation:
Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio
Keith S. Kaye
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan
*
Address correspondence to David van Duin, MD, PhD, Division of Infectious Diseases, CB 7030, University of North Carolina, 130 Mason Farm Road, Chapel Hill, North Carolina 27599 ([email protected]).
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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.

Infect Control Hosp Epidemiol 2015;36(8):942–948

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 8 , August 2015 , pp. 942 - 948
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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