{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:31:01Z","timestamp":1785411061291,"version":"3.56.0"},"reference-count":34,"publisher":"Department of Medicine, Warren Alpert Medical School at Brown University","issue":"1","license":[{"start":{"date-parts":[[2022,12,16]],"date-time":"2022-12-16T00:00:00Z","timestamp":1671148800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"\n Background<\/jats:title>\n \n Carbapenem-resistant\n Klebsiella pneumoniae<\/jats:italic>\n (CRKP) is an important healthcare-associated pathogen. This study aimed to identify factors associated with CRKP isolation among hospitalized patients, describe molecular epidemiology, and mortality associated with CRKP isolation.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We performed a case-control study at two university-affiliated teaching hospitals. We included 150 patients (30 cases and 120 controls). Each patient with CRKP, a case-patient, was matched with four controls by admission facility, admission date, age, and sex. Controls, patients without CRKP, were randomly selected from a computerized list of inpatients whose admission date was the same as that of the case, within 48 hours of the date of the initial positive culture. We calculated the risk of in-hospital death as the number of deaths divided by the number of cases and evaluated the risk of mortality associated with the site of positive culture. Molecular epidemiology investigation using comparison of restricted DNA patterns of CRKP by pulsed-field gel electrophoresis (PFGE) was conducted.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A greater proportion of cases than controls had undergone an invasive procedure, including use of a central vein catheter, or mechanical nutrition by tube feeding. Pre-admission treatment within two months with the following antibiotic classes was associated with CRKP isolation: carbapenems, fluoroquinolones, anti-pseudomonal penicillins, and cephalosporins. The molecular analysis indicated that over 90% of isolates shared similar PFGE patterns. CRKP isolation was associated with significantly higher in-hospital mortality in comparison to controls. Positive cultures from sites other than urine were associated with substantially higher mortality than was a positive urine culture (RR= 4.0).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The use of multiple broad-spectrum antibiotics, multiple comorbid conditions and poor performance status are important risk factors for developing CRKP in a hospitalized population.<\/jats:p>\n <\/jats:sec>","DOI":"10.56305\/001c.57568","type":"journal-article","created":{"date-parts":[[2022,12,30]],"date-time":"2022-12-30T20:22:47Z","timestamp":1672431767000},"source":"Crossref","is-referenced-by-count":0,"title":["Carbapenem-resistant Klebsiella pneumoniae: Risk Factors for Isolation Among Hospitalized Patients"],"prefix":"10.56305","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6249-8746","authenticated-orcid":false,"given":"Ketevan","family":"Kobaidze","sequence":"first","affiliation":[{"name":"Emory University School of Medicine","department":["Emory Division of Hospital Medicine, Emory Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse","family":"Jacob","sequence":"additional","affiliation":[{"name":"Emory University School of Medicine","department":["Emory Division of Infectious Diseases, Emory Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Traci","family":"Leong","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03czfpz43","id-type":"ROR","asserted-by":"publisher"}],"name":"Emory University","department":["Department of Biostatistics and Bioinformatics. Rollins School of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W Dana","family":"Flanders","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03czfpz43","id-type":"ROR","asserted-by":"publisher"}],"name":"Emory University","department":["Department of Biostatistics and Bioinformatics. Rollins School of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"35509","published-online":{"date-parts":[[2022,12,16]]},"reference":[{"issue":"9","key":"ref1","doi-asserted-by":"publisher","first-page":"2233","DOI":"10.1128\/jcm.33.9.2233-2239.1995","article-title":"Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing","volume":"33","author":"F C Tenover","year":"1995","journal-title":"Journal of Clinical Microbiology","ISSN":"https:\/\/id.crossref.org\/issn\/0095-1137","issn-type":"print"},{"issue":"10","key":"ref2","doi-asserted-by":"publisher","first-page":"4511","DOI":"10.1128\/aac.00784-09","article-title":"Regional dissemination of KPC-producing Klebsiella pneumoniae","volume":"53","author":"Brandon Kitchel","year":"2009","journal-title":"Antimicrobial Agents and Chemotherapy","ISSN":"https:\/\/id.crossref.org\/issn\/0066-4804","issn-type":"print"},{"issue":"early release","key":"ref3","first-page":"1","article-title":"Centers for Disease Control and Prevention. Vital signs:carbapenem-resistant enterobacteriaceae","volume":"62","year":"2013","journal-title":"MMWR Morb Mortal Rep"},{"issue":"2","key":"ref4","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1128\/aac.01053-06","article-title":"Plasmid-mediated KPC-2 in a Klebsiella pneumoniae isolate from China","volume":"51","author":"Ze-Qing Wei","year":"2007","journal-title":"Antimicrobial Agents and Chemotherapy","ISSN":"https:\/\/id.crossref.org\/issn\/0066-4804","issn-type":"print"},{"issue":"10","key":"ref5","doi-asserted-by":"publisher","first-page":"4423","DOI":"10.1128\/aac.49.10.4423-4424.2005","article-title":"Plasmid-mediated carbapenem-hydrolyzing beta-lactamase KPC in a Klebsiella pneumoniae isolate from France","volume":"49","author":"Thierry Naas","year":"2005","journal-title":"Antimicrobial Agents and Chemotherapy","ISSN":"https:\/\/id.crossref.org\/issn\/0066-4804","issn-type":"print"},{"issue":"8","key":"ref6","doi-asserted-by":"publisher","first-page":"2880","DOI":"10.1128\/aac.00186-06","article-title":"First detection of the plasmid-mediated class A carbapenemase KPC-2 in clinical isolates of Klebsiella pneumoniae from South America","volume":"50","author":"Maria Virginia Villegas","year":"2006","journal-title":"Antimicrobial Agents and Chemotherapy","ISSN":"https:\/\/id.crossref.org\/issn\/0066-4804","issn-type":"print"},{"issue":"9","key":"ref7","doi-asserted-by":"publisher","first-page":"1138","DOI":"10.1093\/cid\/cir120","article-title":"The challenges of antimicrobial resistance in Brazil","volume":"52","author":"F. 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Bratu","year":"2005","journal-title":"Arch Intern Med"},{"issue":"5","key":"ref11","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1086\/652152","article-title":"Multidrug resistance among gram-negative pathogens that caused healthcare\u2010associated infections reported to the national healthcare safety network, 2006\u20132008","volume":"31","author":"Alexander J. 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Mathers","year":"2009","journal-title":"Transplant Infectious Disease","ISSN":"https:\/\/id.crossref.org\/issn\/1398-2273","issn-type":"print"},{"issue":"4","key":"ref16","doi-asserted-by":"publisher","first-page":"1413","DOI":"10.1128\/aac.01103-07","article-title":"Imipenem-resistant Enterobacter species isolation: the emergence of KPC-none carbapenemase, molecular characterization, epidemiology, and outcomes","volume":"52","author":"Dror Marchaim","year":"2008","journal-title":"Antimicrobial Agents and Chemotherapy","ISSN":"https:\/\/id.crossref.org\/issn\/0066-4804","issn-type":"print"},{"issue":"21","key":"ref17","first-page":"pii=19218","article-title":"KPC-2-producing Klebsiella pneumoniae infections in Greek hospitals are mainly due to a hyperepidemic clone","volume":"14","author":"P. 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Peleg","year":"2010","journal-title":"New England Journal of Medicine","ISSN":"https:\/\/id.crossref.org\/issn\/0028-4793","issn-type":"print"},{"key":"ref23","first-page":"1418","article-title":"Carbapenem-resistant Klebsiella pneumoniae associated with a long-term care facility - West Virginia, 2009-2011","volume":"60","year":"2011","journal-title":"MMWR"},{"issue":"10","key":"ref24","doi-asserted-by":"publisher","first-page":"984","DOI":"10.1086\/667738","article-title":"Outbreak of carbapenem-resistant Enterobacteriacae at a long-term acute care hospital","volume":"33","author":"Amit S. Chitnis","year":"2012","journal-title":"Infection Control & Hospital Epidemiology","ISSN":"https:\/\/id.crossref.org\/issn\/0899-823X","issn-type":"print"},{"issue":"6","key":"ref25","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1086\/660202","article-title":"Community and nursing home residents with carbapenemase-producing Klebsiella pneumoniae infection","volume":"32","author":"John Mills","year":"2011","journal-title":"Infection Control & Hospital Epidemiology","ISSN":"https:\/\/id.crossref.org\/issn\/0899-823X","issn-type":"print"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1017\/ice.2022.4","article-title":"Poor outcomes in both infection and colonization with carbapenem-resistant Enterobacterales","author":"Jessica R. Howard-Anderson","year":"2022","journal-title":"Infection Control & Hospital Epidemiology","ISSN":"https:\/\/id.crossref.org\/issn\/0899-823X","issn-type":"print"},{"key":"ref27","article-title":"Infectious Diseases Society of America Antimicrobial-Resistant Treatment Guidance: Gram-Negative Bacterial Infections","author":"P.D. 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