Mortality in KPC-producing Klebsiella pneumoniae bloodstream infections: a changing landscape.
J Antimicrob Chemother
; 78(10): 2505-2514, 2023 10 03.
Article
en En
| MEDLINE
| ID: mdl-37606528
ABSTRACT
OBJECTIVES:
To assess the impact of carbapenem resistance on mortality in Klebsiella pneumoniae bloodstream infection (BSI) in the era of novel ß-lactam/ß-lactamase inhibitor combinations. MATERIAL ANDMETHODS:
Retrospective study of patients with K. pneumoniae BSI between January and August 2020 in 16 centres (CARBANEW study within the MULTI-SITA project).RESULTS:
Overall, 426 patients were included 107/426 (25%) had carbapenem-resistant K. pneumoniae (CR-Kp) BSI and 319/426 (75%) had carbapenem-susceptible K. pneumoniae (CS-Kp) BSI. Crude cumulative 30 day mortality was 33.8% and 20.7% in patients with, respectively, CR-Kp BSI and CS-Kp BSI (Pâ=â0.027). Carbapenemase production or carbapenemase-encoding genes were detected in 84/98 tested CR-Kp isolates (85.7%), mainly KPC (78/84; 92.9%). Ceftazidime/avibactam was the most frequently used appropriate therapy for CR-Kp BSI (80/107; 74.7%). In multivariable analyses, variables showing an unfavourable association with mortality after correction for multiple testing were age-adjusted Charlson comorbidity index (HR 1.20; 95% CI 1.10-1.31, Pâ<â0.001) and Pitt score (HR 1.33; 95% CI 1.15-1.55, Pâ<â0.001), but not carbapenem resistance (HR 1.28, 95% CI 0.74-2.22, Pâ=â0.410). In a propensity score-matched analysis, there was no difference in mortality between patients appropriately treated with ceftazidime/avibactam for CR-Kp BSI and patients appropriately treated with other agents (mainly meropenem monotherapy or piperacillin/tazobactam monotherapy) for CS-Kp BSI (HR 1.07; 95% CI 0.50-2.29, Pâ=â0.866).CONCLUSIONS:
Our results suggest that the increased mortality in CR-Kp BSI compared with CS-Kp BSI is not (or no longer) dependent on the type of therapy in areas where ceftazidime/avibactam-susceptible KPC-producing isolates are the most prevalent type of CR-Kp.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Infecciones por Klebsiella
/
Bacteriemia
/
Sepsis
Tipo de estudio:
Observational_studies
/
Risk_factors_studies
Límite:
Humans
Idioma:
En
Revista:
J Antimicrob Chemother
Año:
2023
Tipo del documento:
Article
País de afiliación:
Italia