Mortality in KPC-producing Klebsiella pneumoniae bloodstream infections: a changing landscape.

Autor:	Giacobbe DR; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.; Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy., Marelli C; Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy., Cattardico G; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.; Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy., Fanelli C; Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.; Department of Medicine, Surgery and Pharmacy, Unit of Infectious Diseases, University of Sassari, Sassari, Italy., Signori A; Section of Biostatistics, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy., Di Meco G; Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy., Di Pilato V; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy., Mikulska M; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.; Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy., Mazzitelli M; Infectious and Tropical Diseases Unit, Padova University Hospital, Padua, Italy., Cattelan AM; Infectious and Tropical Diseases Unit, Padova University Hospital, Padua, Italy.; Department of Molecular Medicine, University of Padua, Padua, Italy., Pallotto C; Department of Medicine and Surgery, Clinic of Infectious Diseases, 'Santa Maria della Misericordia' Hospital, University of Perugia, Perugia, Italy., Francisci D; Department of Medicine and Surgery, Clinic of Infectious Diseases, 'Santa Maria della Misericordia' Hospital, University of Perugia, Perugia, Italy., Calabresi A; SOC Malattie Infettive, ASO 'SS Antonio e Biagio e C. Arrigo', Alessandria, Italy., Lombardi A; Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy., Gori A; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.; Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Ospedale Luigi Sacco-Polo Universitario, Milan, Italy., Del Bono V; Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy., Aldieri C; Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy., Losito AR; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy., Raffaelli F; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy., Cortegiani A; Department of Surgical, Oncological and Oral Science, University of Palermo, Palermo, Italy.; Department of Anesthesia Analgesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy., Milazzo M; Department of Surgical, Oncological and Oral Science, University of Palermo, Palermo, Italy., Del Puente F; Department of Infectious Diseases, Galliera Hospital, Genoa, Italy., Pontali E; Department of Infectious Diseases, Galliera Hospital, Genoa, Italy., De Rosa FG; Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy.; Unit of Infectious Diseases, Cardinal Massaia, Asti, Italy., Corcione S; Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy., Mularoni A; Unit of Infectious Diseases, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy., Russelli G; Unit of Infectious Diseases, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy., Giacomini M; Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy., Badalucco Ciotta F; Clinic of Infectious Diseases, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy., Oltolini C; Clinic of Infectious Diseases, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy., Serino FS; Azienda ULSS4 Veneto Orientale, UOS Malattie Infettive, UOC Medicina Generale, Ospedale di Portogruaro, Portogruaro, Italy., Momesso E; Azienda ULSS4 Veneto Orientale, UOC Anestesia e Rianimazione, Ospedale di San Donà di Piave, San Donà di Piave, Italy., Spinicci M; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.; Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy., Graziani L; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy., Torti C; Department of Medical and Surgical Sciences, University 'Magna Graecia', Catanzaro, Italy.; Unit of Infectious and Tropical Diseases, 'Mater Domini' Teaching Hospital, Catanzaro, Italy., Trecarichi EM; Department of Medical and Surgical Sciences, University 'Magna Graecia', Catanzaro, Italy.; Unit of Infectious and Tropical Diseases, 'Mater Domini' Teaching Hospital, Catanzaro, Italy., Merli M; Infectious Diseases Clinic, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy., D'Amico F; Infectious Diseases Clinic, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy., Marchese A; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.; UO Microbiologia, IRCCS Ospedale Policlinico San Martino, Genoa, Italy., Vena A; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.; Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy., Bassetti M; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.; Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Jazyk:	angličtina
Zdroj:	The Journal of antimicrobial chemotherapy [J Antimicrob Chemother] 2023 Oct 03; Vol. 78 (10), pp. 2505-2514.
DOI:	10.1093/jac/dkad262
Abstrakt:	Objectives: To assess the impact of carbapenem resistance on mortality in Klebsiella pneumoniae bloodstream infection (BSI) in the era of novel β-lactam/β-lactamase inhibitor combinations. Material and Methods: 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 (P = 0.027). 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, P < 0.001) and Pitt score (HR 1.33; 95% CI 1.15-1.55, P < 0.001), but not carbapenem resistance (HR 1.28, 95% CI 0.74-2.22, P = 0.410). 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, P = 0.866). 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. (© The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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