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J Antimicrob Chemother. 2015 Jul;70(7):2133-43. doi: 10.1093/jac/dkv086. Epub 2015 Apr 21.

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

Author information

1
Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Roma, Italy tumbarello@rm.unicatt.it.
2
Institute of Infectious Diseases, Catholic University of the Sacred Heart, A. Gemelli Hospital, Roma, Italy.
3
Department of Medical Sciences, University of Turin, Torino, Italy Infectious Diseases at Amedeo di Savoia Hospital, Torino, Italy.
4
Clinic of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
5
Infectious Diseases Division, University of Genoa (DISSAL) and IRCCS San Martino-IST, Genoa, Italy.
6
Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy.
7
Institute of Microbiology, Catholic University of the Sacred Heart, A. Gemelli Hospital, Roma, Italy.
8
Microbiology Unit, University of Genoa (DISC) and IRCCS San Martino-IST, Genoa, Italy.
9
Operative Unit of Clinical Microbiology, S. Orsola-Malpighi Hospital, Bologna, Italy.

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.

KEYWORDS:

carbapenem resistance; carbapenemases; colistin resistance; combination therapy; inadequate empirical therapy; meropenem MICs; treatment

PMID:
25900159
DOI:
10.1093/jac/dkv086
[Indexed for MEDLINE]

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