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.
| Original language | English |
|---|---|
| Article number | dkv086 |
| Pages (from-to) | 2133-2143 |
| Number of pages | 11 |
| Journal | Journal of Antimicrobial Chemotherapy |
| Volume | 70 |
| Issue number | 7 |
| DOIs | |
| Publication status | Published - Dec 6 2014 |
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Keywords
- Carbapenem resistance
- Carbapenemases
- Colistin resistance
- Combination therapy
- Inadequate empirical therapy
- Meropenem MICs
- Treatment
ASJC Scopus subject areas
- Pharmacology
- Pharmacology (medical)
- Infectious Diseases
Cite this
Infections caused by KPC-producing Klebsiella pneumoniae : Differences in therapy and mortality in a multicentre study. / 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.
In: Journal of Antimicrobial Chemotherapy, Vol. 70, No. 7, dkv086, 06.12.2014, p. 2133-2143.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Infections caused by KPC-producing Klebsiella pneumoniae
T2 - Differences in therapy and mortality in a multicentre study
AU - Tumbarello, Mario
AU - Trecarichi, Enrico Maria
AU - De Rosa, Francesco Giuseppe
AU - Giannella, Maddalena
AU - Giacobbe, Daniele Roberto
AU - Bassetti, Matteo
AU - Losito, Angela Raffaella
AU - Bartoletti, Michele
AU - Del Bono, Valerio
AU - Corcione, Silvia
AU - Maiuro, Giuseppe
AU - Tedeschi, Sara
AU - Celani, Luigi
AU - Cardellino, Chiara Simona
AU - Spanu, Teresa
AU - Marchese, Anna
AU - Ambretti, Simone
AU - Cauda, Roberto
AU - Viscoli, Claudio
AU - Viale, Pierluigi
PY - 2014/12/6
Y1 - 2014/12/6
N2 - 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.
AB - 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.
KW - Carbapenem resistance
KW - Carbapenemases
KW - Colistin resistance
KW - Combination therapy
KW - Inadequate empirical therapy
KW - Meropenem MICs
KW - Treatment
UR - http://www.scopus.com/inward/record.url?scp=84936929460&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84936929460&partnerID=8YFLogxK
U2 - 10.1093/jac/dkv086
DO - 10.1093/jac/dkv086
M3 - Article
C2 - 25900159
AN - SCOPUS:84936929460
VL - 70
SP - 2133
EP - 2143
JO - Journal of Antimicrobial Chemotherapy
JF - Journal of Antimicrobial Chemotherapy
SN - 0305-7453
IS - 7
M1 - dkv086
ER -