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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2016 Giugno;82(6):635-40
Risk factors for ventilator associated pneumonia due to carbapenemase-producing Klebsiella pneumoniae in mechanically ventilated patients with tracheal and rectal colonization
Francesco SBRANA 1, Paolo MALACARNE 2, Matteo BASSETTI 3, Carlo TASCINI 4, Lara VEGNUTI 2, Paola DELLA SIEGA 3, Andrea RIPOLI 1, Filippo ANSALDI 5, 6, Francesco MENICHETTI 4 ✉
1 U.O. Lipidoaferesi, Fondazione Toscana Gabriele Monasterio, Pisa, Italy; 2 U.O. Anestesia e Rianimazione VI° Pronto Soccorso, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy; 3 Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy; 4 U.O. Malattie Infettive, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy; 5 Department of Health Science, University of Genoa, Genoa, Italy; 6 IRCCS AOU San Martino-IST, Genoa, Italy
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.