Abstract
Background/aimCarbapenem-resistantKlebsiella pneumoniae (CR-KP) infections encountered in urology patients differentiate from infections caused by other factors, both in respect to prophylaxis and treatment stage, and require a special approach. We aimed to analyse the predisposing factors and the antibiotherapies for CR-KP infection outbreak in a tertiary urology clinic.Materials and methods There were 75 patients in the CR-KP positive group (Group I) and 146 patients in the CR-KP negative group (Group II). Analysis of the predisposing factors for CR-KP infection and comparison of the reinfection rate and the antibiotherapies in the 2 groups were the endpoints.ResultsIn the first group, age, comorbidity, previous antibiotic use, and nephrostomy tube rates were higher (P = 0.015, P = 0.001, P = 0.004, and P < 0.001, respectively). In the second group, open urological surgery rate, and the proportion of patients presenting with flank pain, lower urinary tract symptoms, and haematuria were higher (P = 0.029, P < 0.001, P < 0.001, and P = 0.007). In the first group, the proportion of patients treated with transurethral bladder tumour resection was higher, whereas, percutaneous nephrolithotomy was higher in the second group (P = 0.045 for both). While hospitalization and Foley catheterization duration were longer in the first group (P < 0.001 for both), double J stent and nephrostomy duration were longer in the second group (P < 0.001 and P = 0.005). Mean leukocyte count at admission was higher in the first group (P < 0.001).Conclusion Advanced age, comorbidities, previous antibiotic use, and prolonged Foley catheterization duration are predisposing factors for this infection in the urology department. Two-week administration of combination antibiotic regimens containing carbapenem were effective for the treatment of this infection.
Highlights
World-wide increased antibiotic resistance is a global threat to the health system
While hospitalization and Foley catheterization duration were longer in the first group (P < 0.001 for both), double J stent and nephrostomy duration were longer in the second group (P < 0.001 and P = 0.005)
Six patients whose data were not able to reach in the Carbapenem-resistant Klebsiella pneumonia (CRKP) group and 5 patients in the non-Carbapenem-resistant Klebsiella pneumoniae (CR-KP) group were excluded from the study, and the remaining 221 patients were included in the study
Summary
World-wide increased antibiotic resistance is a global threat to the health system. Carbapenem-resistant gram-negative bacteria have become quite another multiresistant infectious agent with limited treatment options. Carbapenem-resistant Klebsiella pneumonia (CRKP) hydrolyses carbapenems via β-lactamase enzyme and shows resistance to many antimicrobial agents [1,2]. These organisms have resistance mechanisms for the second line antibiotics. It has been demonstrated that they may show resistance to the last option antibiotics such as tigecycline and colistin [3,4,5]. The importance of antibiotic stewardship in the management of patients has been highlighted and practical guidelines have been developed
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