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?
Giacobbe, D. R., Marelli, C., Cattardico, G., Fanelli, C., Signori, A., Di Meco, G., Di Pilato, V., Mikulska, M., Mazzitelli, M., Cattelan, A. M., Pallotto, C., Francisci, D., Calabresi, A., Lombardi, A., Gori, A., Del Bono, V., Aldieri, C., Losito, A. R., Raffaelli, F., Cortegiani, A., Milazzo, M., Del Puente, F., Pontali, E., De Rosa, F. G., Corcione, S., Mularoni, A., Russelli, G., Giacomini, M., Badalucco Ciotta, F., Oltolini, C., Serino, F. S., Momesso, E., Spinicci, M., Graziani, L., Torti, C., Trecarichi, E. M., Merli, M., D'Amico, F., Marchese, A., Vena, A., Bassetti, M., Mortality in KPC-producing Klebsiella pneumoniae bloodstream infections: a changing landscape, <<JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY>>, 2023; 78 (10): 2505-2514. [doi:10.1093/jac/dkad262] [https://hdl.handle.net/10807/337127]
Mortality in KPC-producing Klebsiella pneumoniae bloodstream infections: a changing landscape
Mazzitelli, Maria;Losito, Angela Raffaella;Raffaelli, Francesca;Torti, Carlo;Trecarichi, Enrico Maria;
2023
Abstract
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?
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