Published 2015
| Version v1
Publication
Infections caused by KPC-producing Klebsiella pneumoniae: Differences in therapy and mortality in a multicentre study
Creators
- Tumbarello, Mario
- Trecarichi, Enrico Maria
- De Rosa, Francesco Giuseppe
- Giannella, Maddalena
- GIACOBBE, DANIELE ROBERTO
- Bassetti, Matteo
- Losito, Angela Raffaella
- Bartoletti, Michele
- DEL BONO, VALERIO
- Corcione, Silvia
- Maiuro, Giuseppe
- Tedeschi, Sara
- Celani, Luigi
- Cardellino, Chiara Simona
- Spanu, Teresa
- MARCHESE, ANNA
- Ambretti, Simone
- Cauda, Roberto
- VISCOLI, CLAUDIO
- Viale, Pierluigi
Contributors
Others:
- Tumbarello, Mario
- Trecarichi, Enrico Maria
- De Rosa, Francesco Giuseppe
- Giannella, Maddalena
- Giacobbe, DANIELE ROBERTO
- Bassetti, Matteo
- Losito, Angela Raffaella
- Bartoletti, Michele
- DEL BONO, Valerio
- Corcione, Silvia
- Maiuro, Giuseppe
- Tedeschi, Sara
- Celani, Luigi
- Cardellino, Chiara Simona
- Spanu, Teresa
- Marchese, Anna
- Ambretti, Simone
- Cauda, Roberto
- Viscoli, Claudio
- Viale, Pierluigi
Description
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.
Additional details
Identifiers
- URL
- http://hdl.handle.net/11567/818372
- URN
- urn:oai:iris.unige.it:11567/818372
Origin repository
- Origin repository
- UNIGE