Outcomes and Predictors of Mortality in Patients With KPC-Kp Infections Treated With Meropenem Vaborbactam: An Observational Multicenter Study.

Autor: Tumbarello M; Department of Medical Biotechnologies, University of Siena, Siena, Italy.; Infectious and Tropical Diseases Unit, Azienda Ospedaliero Universitaria Senese, Siena, Italy., Raffaelli F; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy., Giannella M; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy., De Pascale G; Dipartimento di Scienze Biotecnologiche di base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy.; Dipartimento di Scienza dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy., Cascio A; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G D'Alessandro', University of Palermo, Palermo, Italy.; Infectious and Tropical Disease Unit, AOU Policlinico 'P. Giaccone'  Palermo, Italy., De Rosa FG; Infectious diseases, Department of Medical Sciences, University of Turin, Torino, Italy., Cattelan AM; Infectious and Tropical Diseases Unit, Padua University Hospital, Padova, Italy.; Department of Molecular Medicine, University of Padova, Padova, Italy., Oliva A; Dipartimento di Sanità Pubblica e Malattie Infettive, Università Sapienza, Roma, Italy., Saracino A; Operative Unit of Infectious Diseases, Hospital-University Polyclinic of Bari, Bari, Italy., Bassetti M; Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy.; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy., Mussini C; Clinica delle Malattie Infettive, Università di Modena e Reggio Emilia, Modena, Italy., Luzzati R; Infectious Diseases Unit, University Hospital of Trieste, Trieste, Italy., Capone A; Infezioni Sistemiche ed Immunodepresso, National Institute for Infectious Disease L. Spallanzani, Roma, Italy., Signorini L; UOC Malattie Infettive, Spedali Civili di Brescia, Brescia, Italy., Bartoletti M; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.; Infectious Diseases Unit, IRCCS Humanitas Research Hospital, Milan, Italy., Sambo M; Department of Medical Biotechnologies, University of Siena, Siena, Italy.; Infectious and Tropical Diseases Unit, Azienda Ospedaliero Universitaria Senese, Siena, Italy., Sarmati L; Clinical Infectious Diseases, Department of System Medicine, Tor Vergata University, Roma  Italy., Antinori S; Dipartiment of Scienze Biomediche e Cliniche L. Sacco, Università degli Studi di Milano Polo Universitario, Milano, Italy., Mularoni A; Infectious Diseases Unit, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy., Tascini C; Infectious Disease Clinic, DAME (Department of Medicine) University of Udine, Udine  Italy., Corona A; ICU, Surgical Theatre & Emergency Department, ASST Valcamonica, Breno  Italy., Pascale R; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy., Rubino R; Infectious and Tropical Disease Unit, AOU Policlinico 'P. Giaccone'  Palermo, Italy., Corcione S; Infectious diseases, Department of Medical Sciences, University of Turin, Torino, Italy., Mazzitelli M; Infectious and Tropical Diseases Unit, Padua University Hospital, Padova, Italy., Giuliano G; Infectious and Tropical Diseases Unit, Azienda Ospedaliero Universitaria Senese, Siena, Italy., Lovecchio A; Infectious Diseases Unit, University Hospital of Trieste, Trieste, Italy., Bavaro DF; Operative Unit of Infectious Diseases, Hospital-University Polyclinic of Bari, Bari, Italy., Meschiari M; Clinica delle Malattie Infettive, Università di Modena e Reggio Emilia, Modena, Italy., Montagnani F; Department of Medical Biotechnologies, University of Siena, Siena, Italy.; Infectious and Tropical Diseases Unit, Azienda Ospedaliero Universitaria Senese, Siena, Italy., Fabbiani M; Department of Medical Biotechnologies, University of Siena, Siena, Italy.; Infectious and Tropical Diseases Unit, Azienda Ospedaliero Universitaria Senese, Siena, Italy., De Benedetto I; Infectious diseases, Department of Medical Sciences, University of Turin, Torino, Italy., Antonelli M; Dipartimento di Scienze Biotecnologiche di base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy.; Dipartimento di Scienza dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy., Venditti M; Dipartimento di Sanità Pubblica e Malattie Infettive, Università Sapienza, Roma, Italy., Viale P; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Jazyk: angličtina
Zdroj: Open forum infectious diseases [Open Forum Infect Dis] 2024 May 08; Vol. 11 (6), pp. ofae273. Date of Electronic Publication: 2024 May 08 (Print Publication: 2024).
DOI: 10.1093/ofid/ofae273
Abstrakt: Background: Meropenem-vaborbactam is a recent and promising option for the treatment of KPC-producing Klebsiella pneumoniae (KPC-Kp) infections, including those resistant to ceftazidime-avibactam.
Methods: We conducted a retrospective analysis of observational data from 19 Italian hospitals on use and outcomes of patients treated with meropenem-vaborbactam for at least ≥24 hours for KPC-Kp infections. Crude and propensity-weighted multiple Cox regression models were performed to ascertain risk factors independently associated with 30-day mortality.
Results: The cohort included 342 adults with bloodstream infections (n = 172) and nonbacteremic infections (n = 170), of which 107 were lower respiratory tract infections, 30 were complicated urinary tract infections, and 33 were infections involving other sites. Most infections (62.3%) were managed with meropenem-vaborbactam monotherapy, or in combination with at least 1 other active drug (usually fosfomycin, tigecycline, or gentamicin) (37.7%). The 30-day mortality rate was 31.6% (108/342). In multiple Cox regression model, 30-day mortality was independently associated with septic shock at infection onset, Charlson comorbidity index ≥ 3, dialysis, concomitant COVID-19, and INCREMENT score ≥ 8. Administration of meropenem-vaborbactam within 48 hours from infection onset was a negative predictor of mortality. All predictors, except administration of meropenem-vaborbactam within 48 hours, remained significant when the multiple Cox regression model was repeated after adjustment for the propensity score for receipt of combination therapy.
Conclusions: Despite the limits of a retrospective study, the data derived from this multicenter cohort provide additional evidence on the efficacy of meropenem-vaborbactam in treating severe KPC-Kp infections, even when used as monotherapy.
Competing Interests: Potential conflicts of interest. No reported conflicts of interest
(© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze: MEDLINE
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