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.

Tumbarello, M., Raffaelli, F., Giannella, M., De Pascale, G., Cascio, A., De Rosa, F. G., Cattelan, A. M., Oliva, A., Saracino, A., Bassetti, M., Mussini, C., Luzzati, R., Capone, A., Signorini, L., Bartoletti, M., Sambo, M., Sarmati, L., Antinori, S., Mularoni, A., Tascini, C., Corona, A., Pascale, R., Rubino, R., Corcione, S., Mazzitelli, M. L., Giuliano, G., Lovecchio, A., Bavaro, D. F., Meschiari, M., Montagnani, F., Fabbiani, M., De Benedetto, I., Antonelli, M., Venditti, M., Viale, P., Outcomes and Predictors of Mortality in Patients With KPC-Kp Infections Treated With Meropenem Vaborbactam: An Observational Multicenter Study, <<OPEN FORUM INFECTIOUS DISEASES>>, N/A; 11 (6): N/A-N/A. [doi:10.1093/ofid/ofae273] [https://hdl.handle.net/10807/297459]

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

Tumbarello, Mario;Raffaelli, Francesca;De Pascale, Gennaro;Signorini, Liana;Tascini, Carlo;Mazzitelli, Mariagrazia Luisa;Meschiari, Marianna;Antonelli, Massimo;Venditti, Mario;
2024

Abstract

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.
2024
Inglese
Tumbarello, M., Raffaelli, F., Giannella, M., De Pascale, G., Cascio, A., De Rosa, F. G., Cattelan, A. M., Oliva, A., Saracino, A., Bassetti, M., Mussini, C., Luzzati, R., Capone, A., Signorini, L., Bartoletti, M., Sambo, M., Sarmati, L., Antinori, S., Mularoni, A., Tascini, C., Corona, A., Pascale, R., Rubino, R., Corcione, S., Mazzitelli, M. L., Giuliano, G., Lovecchio, A., Bavaro, D. F., Meschiari, M., Montagnani, F., Fabbiani, M., De Benedetto, I., Antonelli, M., Venditti, M., Viale, P., Outcomes and Predictors of Mortality in Patients With KPC-Kp Infections Treated With Meropenem Vaborbactam: An Observational Multicenter Study, <<OPEN FORUM INFECTIOUS DISEASES>>, N/A; 11 (6): N/A-N/A. [doi:10.1093/ofid/ofae273] [https://hdl.handle.net/10807/297459]
File in questo prodotto:
File Dimensione Formato  
DeP OFID 2024.pdf

accesso aperto

Licenza: Creative commons
Dimensione 843.54 kB
Formato Adobe PDF
843.54 kB Adobe PDF Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10807/297459
Citazioni
  • ???jsp.display-item.citation.pmc??? 1
  • Scopus 2
  • ???jsp.display-item.citation.isi??? 3
social impact