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Medical Science Monitor Basic Research


eISSN: 1643-3750

Risk Factors of Carbapenem-Resistant Klebsiella pneumoniae Infection: A Serious Threat in ICUs

Aslıhan Candevir Ulu, Behice Kurtaran, Ayse Seza Inal, Süheyla Kömür, Filiz Kibar, Hatice Yapıcı Çiçekdemir, Seval Bozkurt, Derya Gürel, Fatma Kılıç, Akgün Yaman, Hasan Salih Zeki Aksu, Yeşim Taşova

Department of Infectious Diseases, Çukurova University, Adana, Turkey

Med Sci Monit 2015; 21:219-224

DOI: 10.12659/MSM.892516

Available online:

Published: 2015-01-17

Background: Nosocomial infections caused by Carbapenem-resistant Klebsiella pneumoniae (CRKP) are increasing. Our aim in this study was to investigate the risk factors of CRKP infections.
Material and Methods: A retrospective cohort study was performed between 1 January and 31 December 2012 in ICU patients. Data was taken from the hospital infection control database for CRKP. The clinical samples collected from the patients were tested by an automatized system and disk diffusion. SPSS software v11.5 was used for statistical analysis.
Results: Totally, 105 Klebsiella pneumoniae isolates were found in 2012 and the carbapenem resistance rate was 48%. The first episode of infection was taken into risk factor analysis. Of the 98 patients, 61 (62.2%) were male and the mean and median ages were 30.4±29.8 and 25 (0–93). The length of stay was longer in the resistant group (p=0.026). Mortality was 48% in the whole group and similar between groups (p=0.533). There was a relationship between meropenem and third-generation cephalosporin use and resistance (OR 3.244 (1.193–8.819) and OR: 3.590 (1.056–12.209). The other risk factors in univariate analysis were: Immunosuppression OR: 2.186 (1.754–2.724), nasogastric catheter OR: 3.562 (1.317–9.634), peripheral arterial catheter OR: 2.545 (1.027–6.307), and being admitted to the neurosurgical unit OR: 4.324 (1.110–16.842).
Conclusions: Restriction of third-generation cephalosporin and carbapenem use and invasive procedures, along with infection control precautions and disinfection policies, may be effective in reducing the carbapenem resistance in ICUs.

Keywords: Adult, Adolescent, Aged, 80 and over, Automation, Carbapenems - chemistry, Child, Child, Preschool, Cross Infection - microbiology, Drug Resistance, Bacterial, Infant, Newborn, Intensive Care Units, Klebsiella Infections - microbiology, Klebsiella pneumoniae - drug effects, Multivariate Analysis, Risk Factors, Software, young adult