Mortality-related factors in patients with OXA-48 carbapenemase-producing Klebsiella pneumoniae bacteremia.

Autor:	Rodríguez OL; Infectious Disease Unit, Internal Medicine Department, University Hospital Complex of Vigo., Sousa A; Infectious Disease Unit, Internal Medicine Department, University Hospital Complex of Vigo.; Biomedical Research Institute Galicia Sur., Pérez-Rodríguez MT; Infectious Disease Unit, Internal Medicine Department, University Hospital Complex of Vigo.; Biomedical Research Institute Galicia Sur., Martínez-Lamas L; Biomedical Research Institute Galicia Sur.; Microbiology Department., Suárez RL; Infectious Disease Unit, Internal Medicine Department, University Hospital Complex of Vigo.; Biomedical Research Institute Galicia Sur., Martínez CT; Infectious Disease Unit, Internal Medicine Department, University Hospital Complex of Vigo., Pino CP; Infectious Disease Unit, Internal Medicine Department, University Hospital Complex of Vigo., Vidal FV; Microbiology Department., Pérez-Landeiro A; Pharmacy Department, University Hospital Complex of Vigo, Spain., Casal MC; Infectious Disease Unit, Internal Medicine Department, University Hospital Complex of Vigo.; Biomedical Research Institute Galicia Sur.
Jazyk:	angličtina
Zdroj:	Medicine [Medicine (Baltimore)] 2021 Apr 09; Vol. 100 (14), pp. e24880.
DOI:	10.1097/MD.0000000000024880
Abstrakt:	Abstract: Carbapenemase-producing Enterobacterales constitute a serious public health threat; however, information on the oxacilinasa (OXA-48)-type is limited. The objective of the study was to evaluate the risk factors associated with 14-day mortality for patients with bacteremia due to OXA-48 carbapenemase-producing Klebsiella pneumoniae.We conducted a retrospective, single-center observational study of adult patients with K. pneumoniae bacteremia, classifying the strains as carbapenem-susceptible K. pneumoniae (CSKp) and carbapenem-resistant K. pneumoniae (CRKp). All of the CRKp strains were the OXA-48-type.The study included 202 cases of bacteremia: 114 due to CSKp and 88 due to CRKp. The clinical cure rate was higher for the patients with CSKp (85% vs 69% for CSKp and CRKp, respectively; P = .010), while the 14-day mortality rate was lower (13% vs 30%, P = .005). An INCREMENT-CPE score ≥7 (HR 3.05, 95% CI 1.50-6.25, P = .002) was the only independent factor associated with 14-day mortality for the patients with Klebsiella spp. bacteremia. Other factors related to 14-day mortality were a rapidly fatal prognosis (McCabe) (HR 7.1, 95% CI 2.75-18.37, P < .001), dementia (HR 5.9, 95% CI 2.0-7.43, P = .001), and a high-risk source of infection (HR 2.7, 95% CI 1.06-6.82, P = .038).The most important factors associated with 14-day mortality for the patients with K. pneumoniae bacteremia was an INCREMENT-CPE score ≥7, dementia, a McCabe score indicating a rapidly fatal prognosis and a high-risk source of infection. We found no relationship between a poorer outcome and CRKp isolation or inadequate antibiotic therapy. Competing Interests: The authors have no funding and conflicts of interest to disclose. (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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