J Korean Med Sci.  2013 Aug;28(8):1187-1193. 10.3346/jkms.2013.28.8.1187.

Higher Prevalence of Klebsiella pneumoniae Extended-Spectrum beta-Lactamase in Patients on Renal Replacement Therapy

• Lee HL
• Whang DH
• Park DW
• Lee YJ
• Kim YH
• Chin HJ
• Kim S
• Koo HS

• KMID: 1793024
• DOI: http://doi.org/10.3346/jkms.2013.28.8.1187

Abstract

The prevalence of antibiotic resistance is higher in patients undergoing renal replacement therapy (RRT) than in patients who did not undergo RRT. We investigated the presence of KP (Klebsiella pneumoniae) in patients who underwent RRT. All data were collected retrospectively by accessing patient medical records from 2004 to 2011 for the culture results of all patients who were positive for KP. We grouped the patients by the presence of extended-spectrum beta-lactamase (ESBL) into a KP ESBL(-) group (KP[-]) and a KP ESBL(+) group (KP[+]). In total, 292 patients (23.1%) were in the KP(+) group, and 974 patients (76.9%) were in the KP(-) group. A greater percentage of KP(+) was found in patients who underwent RRT (7.5%) than in patients who did not undergo RRT (3.2%) (OR, 2.479; 95% CI,1.412-4.352). A Cox's hazard proportional model analysis was performed, and for patients with pneumonia, the risk of KP(+) was 0.663 times higher in patients who had lower albumin levels, 2.796 times higher in patients who had an inserted Levin tube, and 4.551 times higher in patients who underwent RRT. In conclusion, RRT can be a risk factor for KP(+) in patients with pneumonia.

Keyword

Klebsiella pneumoniae; Extended-Spectrum beta-Lactamase; Dialysis

MeSH Terms

Adult
Aged
Aged, 80 and over
Female
Humans
Kaplan-Meier Estimate
Kidney Failure, Chronic/*microbiology/therapy
Klebsiella Infections/*epidemiology/microbiology/mortality
Klebsiella pneumoniae/*enzymology/isolation & purification
Male
Middle Aged
Odds Ratio
Pneumonia/diagnosis/*epidemiology/microbiology
Prevalence
Proportional Hazards Models
Renal Replacement Therapy
Retrospective Studies
Risk Factors
Serum Albumin/analysis
beta-Lactamases/*metabolism
beta-Lactamases
Serum Albumin

Figure

• 

  Fig. 1 Kaplan-Meier analysis for the probability of being free of death. The probability of non-mortality in the KP(+) group was higher than that in the KP(-) group. The number below the figure is the number of patients at each time period. (A) In all patients, (B) in patients with pneumonia.

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