Clinical and epidemiological characteristics of KPC-producing Klebsiella pneumoniae from bloodstream infections in a tertiary referral center in Italy.
Adult
Aged
Anti-Bacterial Agents
/ therapeutic use
Bacterial Proteins
/ metabolism
Drug Resistance, Bacterial
/ genetics
Female
Humans
Italy
/ epidemiology
Kaplan-Meier Estimate
Klebsiella Infections
/ diagnosis
Klebsiella pneumoniae
/ enzymology
Male
Middle Aged
Prognosis
Retrospective Studies
Severity of Illness Index
Shock, Septic
/ complications
Tertiary Care Centers
beta-Lactamases
/ metabolism
Bloodstream infections
Colistin resistance
KPC
Klebsiella pneumoniae
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
12 Jul 2019
12 Jul 2019
Historique:
received:
20
02
2019
accepted:
08
07
2019
entrez:
14
7
2019
pubmed:
14
7
2019
medline:
19
9
2019
Statut:
epublish
Résumé
Bloodstream infections (BSI) due to Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-Kp) have become an important problem and they are associated with a high mortality rate. The aim of our study was to evaluate the clinical and epidemiological characteristics of KPC-Kp from BSIs. In this retrospective cohort study, conducted in a tertiary referral center in Italy, 112 patients with KPC-Kp BSIs diagnosed between February 2011 and December 2015 were identified. We evaluated the mortality at 30 days from the first positive blood culture. Survivor and non-survivor subgroups were compared to identify predictors of mortality. The overall crude mortality was 35%. APACHE II score ≥ 15, septic shock at BSI onset, immunosuppressive therapy during the 30 days before the BSI onset, and the lack of a combination therapy with at least 2 active drugs emerged as independent predictors of mortality. Excluding patients with inadequate therapy, the mortality decreased to 25% while an APACHE II score ≥ 15 and the presence of septic shock remained independently associated with a negative outcome. Two different pulsotypes were identified: pulsotype A belonged to ST512 and carried KPC-3 and pulsotype B belonged to ST307 and carried KPC-2. This study confirmed a high mortality rate of KPC-Kp BSIs. The outcome is heavily influenced by the patient's clinical conditions. A therapeutic approach including a combination with at least two active drugs in vitro can improve the prognosis, unless patients received an appropriate therapy.
Sections du résumé
BACKGROUND
BACKGROUND
Bloodstream infections (BSI) due to Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-Kp) have become an important problem and they are associated with a high mortality rate. The aim of our study was to evaluate the clinical and epidemiological characteristics of KPC-Kp from BSIs.
METHODS
METHODS
In this retrospective cohort study, conducted in a tertiary referral center in Italy, 112 patients with KPC-Kp BSIs diagnosed between February 2011 and December 2015 were identified. We evaluated the mortality at 30 days from the first positive blood culture. Survivor and non-survivor subgroups were compared to identify predictors of mortality.
RESULTS
RESULTS
The overall crude mortality was 35%. APACHE II score ≥ 15, septic shock at BSI onset, immunosuppressive therapy during the 30 days before the BSI onset, and the lack of a combination therapy with at least 2 active drugs emerged as independent predictors of mortality. Excluding patients with inadequate therapy, the mortality decreased to 25% while an APACHE II score ≥ 15 and the presence of septic shock remained independently associated with a negative outcome. Two different pulsotypes were identified: pulsotype A belonged to ST512 and carried KPC-3 and pulsotype B belonged to ST307 and carried KPC-2.
CONCLUSIONS
CONCLUSIONS
This study confirmed a high mortality rate of KPC-Kp BSIs. The outcome is heavily influenced by the patient's clinical conditions. A therapeutic approach including a combination with at least two active drugs in vitro can improve the prognosis, unless patients received an appropriate therapy.
Identifiants
pubmed: 31299943
doi: 10.1186/s12879-019-4268-9
pii: 10.1186/s12879-019-4268-9
pmc: PMC6625039
doi:
Substances chimiques
Anti-Bacterial Agents
0
Bacterial Proteins
0
beta-Lactamases
EC 3.5.2.6
carbapenemase
EC 3.5.2.6
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
611Références
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