TITLE

Infections caused by KPC-producing Klebsiella pneumoniae: differences in therapy and mortality in a multicentre study

AUTHOR(S)
Tumbarello, Mario; Trecarichi, Enrico Maria; De Rosa, Francesco Giuseppe; Giannella, Maddalena; Giacobbe, Daniele Roberto; Bassetti, Matteo; Losito, Angela Raffaella; Bartoletti, Michele; Del Bono, Valerio; Corcione, Silvia; Maiuro, Giuseppe; Tedeschi, Sara; Celani, Luigi; Cardellino, Chiara Simona; Spanu, Teresa; Marchese, Anna; Ambretti, Simone; Cauda, Roberto; Viscoli, Claudio; Viale, Pierluigi
PUB. DATE
July 2015
SOURCE
Journal of Antimicrobial Chemotherapy (JAC);Jul2015, Vol. 70 Issue 7, p2133
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Objectives: Infections caused by Klebsiella pneumoniae (Kp) carbapenemase (KPC)-producing strains of Kp have become a significant threat in recent years. To assess their outcomes and identify risk factors for 14 day mortality, we conducted a 4 year (2010-13) retrospective cohort study in five large Italian teaching hospitals. Methods: The cohort included 661 adults with bloodstream infections (BSIs; n=447) or non-bacteraemic infections (lower respiratory tract, intra-abdominal structure, urinary tract or other sites) caused by a KPC-Kp isolate. All had received ≥48 h of therapy (empirical and/or non-empirical) with at least one drug to which the isolate was susceptible. Results: Most deaths occurred within 2 weeks of infection onset (14 day mortality: 225/661, 34.1%). Logistic regression analysis identified BSI (OR, 2.09; 95% CI, 1.34-3.29), presentation with septic shock (OR, 2.45; 95% CI, 1.47-4.08), inadequate empirical antimicrobial therapy (OR, 1.48; 95% CI, 1.01-2.18), chronic renal failure (OR, 2.27; 95% CI, 1.44-3.58), high APACHE III score (OR, 1.05; 95% CI, 1.04-1.07) and colistin-resistant isolates (OR, 2.18; 95% CI, 1.37-3.46) as independent predictors of 14 day mortality. Combination therapy with at least two drugs displaying in vitro activity against the isolate was associated with lower mortality (OR, 0.52; 95% CI, 0.35-0.77), in particular in patients with BSIs, lung infections or high APACHE III scores and/or septic shock at infection onset. Combinations that included meropenem were associated with significantly higher survival rates when the KPC-Kp isolate had a meropenem MIC of ≤8 mg/L. Conclusions: KPC-Kp infections are associated with high mortality. Treatment with two or more drugs displaying activity against the isolate improves survival, mainly in patients who are critically ill.
ACCESSION #
109035210

 

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