Reduced Incidence of Carbapenem-Resistant Klebsiella pneumoniae Infections in Cardiac Surgery Patients after Implementation of an Antimicrobial Stewardship Project.

Giacobbe Giacobbe,Puente Puente,Santini Santini,Viscoli Viscoli,Campanini Campanini,Marchese Marchese,Salsano Salsano,Mariscalco Mariscalco

doi:10.3390/antibiotics8030132

Abstract

Infections due to carbapenem-resistant Klebsiella pneumoniae (CR-Kp) are associated with increased mortality in cardiac surgery patients. In this short communication, we report on the changes in the incidence of CR-Kp colonization and CR-Kp infection in cardiac surgery patients from 2014 to 2018 in a teaching hospital in Italy, after the implementation of an antimicrobial stewardship project in 2014. During the study period, 2261 patients underwent open-heart surgery. Of them, 130 were found to be colonized by CR-Kp (5.7%) and 52 developed a postoperative CR-Kp infection (2.3%). The crude in-hospital mortality in patients with CR-Kp infections was 48% (25/52). The incidences of both CR-Kp colonization (incidence rate ratio (IRR) 0.82, 95% confidence intervals (CI) 0.78–0.86, p < 0.001) and CR-Kp infection (IRR 0.76, 95% CI 0.69–0.83, p < 0.001) considerably decreased over the study period. This encouraging result should prompt further concerted efforts, directed towards retaining the positive impact of stewardship and infection-control interventions on CR-Kp-related morbidity in the long term.

Highlights

Infections due to carbapenem-resistant Klebsiella pneumoniae (CR-Kp) are associated with increased mortality in cardiac surgery patients [1]
One of the major reasons is the paucity of therapeutic options, since CR-Kp very frequently shows concomitant resistance to several other antibiotics, besides carbapenems [8]
After implementation of an antimicrobial stewardship project, consisting in the evaluation by an infectious diseases specialist of each prescription of antimicrobials impacting antibiotic resistance [5], we observed a significant decrease in the incidence of CR-Kp colonization and CR-Kp infection in cardiac surgery patients

Summary

Introduction

Infections due to carbapenem-resistant Klebsiella pneumoniae (CR-Kp) are associated with increased mortality in cardiac surgery patients [1]. Antibiotics 2019, 8, 132 aimed both at reducing mortality of CR-Kp infection (by improving the adequate use of antibiotics) and reducing the incidence of CR-Kp colonization and infection (by relieving selective pressure for further development and spread of resistance) [5,7]. In this short communication,we wereport reporton on the the changes changes in colonization communication, in the theincidence incidenceofofCR-Kp. CR-Kp infection in cardiac surgery the implementation of an antimicrobial andand. CR-Kp infection in cardiac surgery patientspatients after theafter implementation of an antimicrobial stewardship stewardship project in a teaching hospital in Italy. To curtail mortality of infections due to these difficult-to-treat resistant bacteria, possible non-mutually exclusive interventions are: (i) Development of novel antimicrobial options for effectively treating CR-Kp infections [4]; (ii) implementation of infection-control measures for reducing in-hospital transmission of CR-Kp [5,6]; (iii) implementation of antimicrobial stewardship measures, aimed both at reducing mortality of CR-Kp infection (by improving the adequate use of antibiotics) and reducing the incidence of CR-Kp colonization and infection (by relieving selective pressure for further development and spread of resistance) [5,7].

Methods

Results

Conclusion