Risk factors for acquisition of OXA-48-producing Klebsiella pneumonia among contact patients: a multicentre study

J Hosp Infect. 2018 Mar;98(3):253-259. doi: 10.1016/j.jhin.2017.08.024. Epub 2017 Sep 4.

Abstract

Background: Cohorting carbapenemase-producing Enterobacteriaceae (CPE) carriers during hospitalization limits in-hospital spreading.

Aim: To identify risk factors for CPE acquisition among contacts of an index patient in non-cohorted populations.

Methods: A multicentre retrospective matched case-control study was conducted in five hospitals. Each contact patient (case) who acquired Klebsiella pneumoniae (KP)-OXA-48 from an index patient was compared to three contact (controls) with the same index patients matched with hospitalization in the same unit and similar exposure times.

Findings: Fifty-one secondary cases and 131 controls were included. By univariate analysis, exposure time (odds ratio: 1.06; 95% confidence interval: 1.02-1.1; P = 0.006), concomitant infection at admission (3.23; 1.42-7.35; P = 0.005), antimicrobial therapy within the last month before hospitalization (2.88; 1.34-6.2; P = 0.007), antimicrobial therapy during the exposure time (5.36; 2.28-12.6; P < 0.001), use of at least one invasive procedure (2.99; 1.25-7.15; P = 0.014), number of invasive procedures (1.52; 1.05-2.19; P = 0.025), and geographical proximity (2.84; 1.15-7.00; P = 0.023) were associated with CPE acquisition. By multivariate analysis, antimicrobial therapy during the exposure time (odds ratio: 6.36; 95% confidence interval: 2.46-16.44; P < 0.001), at least one invasive procedure (2.92; 1.04-8.17; P = 0.041), and geographical proximity (3.69; 1.15-11.86; P = 0.028) were associated with acquisition.

Conclusion: In this study, geographical proximity, invasive procedure, and antimicrobial therapy during exposure time were significantly associated with KP-OXA-48 acquisition.

Keywords: Carbapenemase-producing Enterobacteriaceae; Carbapenemases; Contact patients; OXA-48; Risk factors; Screening.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Humans
  • Klebsiella Infections / epidemiology*
  • Klebsiella Infections / microbiology*
  • Klebsiella pneumoniae / enzymology*
  • Klebsiella pneumoniae / isolation & purification*
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Young Adult
  • beta-Lactamases / analysis*

Substances

  • beta-Lactamases
  • oxacillinase