BACKGROUND: The increased frequency of bacteraemias caused by pandrug-resistant Klebsiella pneumoniae (PDR-Kp) has significant implications. The aim of the present study was to identify predictors associated with mortality of PDR-Kp bacteraemias. METHODS: Patients with monomicrobial bacteraemia due to PDR-Kp were included. K. pneumoniae was considered PDR if it showed resistance to all available groups of antibiotics. Primary outcome was 30-day mortality. Minimum inhibitory concentrations (MICs) of meropenem, tigecycline, fosfomycin, and ceftazidime/avibactam were determined by Etest, whereas for colistin, the broth microdilution method was applied. bla KPC, bla VIM, bla NDM, and bla OXA genes were detected by PCR. RESULTS: Among 115 PDR-Kp bacteraemias, the majority of infections were primary bacteraemias (53; 46.1%), followed by catheter-related (35; 30.4%). All isolates were resistant to tested antimicrobials. bla KPC was the most prevalent carbapenemase gene (98 isolates; 85.2%). Thirty-day mortality was 39.1%; among 51 patients with septic shock, 30-day mortality was 54.9%. Multivariate analysis identified the development of septic shock, Charlson comorbidity index, and bacteraemia other than primary or catheter-related as independent predictors of mortality, while a combination of at least three antimicrobials was identified as an independent predictor of survival. CONCLUSIONS: Mortality of PDR-Kp bloodstream infections was high. Administration of at least three antimicrobials might be beneficial for infections in critically ill patients caused by such pathogens.
BACKGROUND: The increased frequency of bacteraemias caused by pandrug-resistant Klebsiella pneumoniae (PDR-Kp) has significant implications. The aim of the present study was to identify predictors associated with mortality of PDR-Kp bacteraemias. METHODS:Patients with monomicrobial bacteraemia due to PDR-Kp were included. K. pneumoniae was considered PDR if it showed resistance to all available groups of antibiotics. Primary outcome was 30-day mortality. Minimum inhibitory concentrations (MICs) of meropenem, tigecycline, fosfomycin, and ceftazidime/avibactam were determined by Etest, whereas for colistin, the broth microdilution method was applied. bla KPC, bla VIM, bla NDM, and bla OXA genes were detected by PCR. RESULTS: Among 115 PDR-Kp bacteraemias, the majority of infections were primary bacteraemias (53; 46.1%), followed by catheter-related (35; 30.4%). All isolates were resistant to tested antimicrobials. bla KPC was the most prevalent carbapenemase gene (98 isolates; 85.2%). Thirty-day mortality was 39.1%; among 51 patients with septic shock, 30-day mortality was 54.9%. Multivariate analysis identified the development of septic shock, Charlson comorbidity index, and bacteraemia other than primary or catheter-related as independent predictors of mortality, while a combination of at least three antimicrobials was identified as an independent predictor of survival. CONCLUSIONS:Mortality of PDR-Kp bloodstream infections was high. Administration of at least three antimicrobials might be beneficial for infections in critically illpatients caused by such pathogens.
Entities:
Keywords:
bacteraemia; carbapenem-resistance; carbapenemase; intensive care unit (ICU); pandrug-resistance
Authors: Mervyn Singer; Clifford S Deutschman; Christopher Warren Seymour; Manu Shankar-Hari; Djillali Annane; Michael Bauer; Rinaldo Bellomo; Gordon R Bernard; Jean-Daniel Chiche; Craig M Coopersmith; Richard S Hotchkiss; Mitchell M Levy; John C Marshall; Greg S Martin; Steven M Opal; Gordon D Rubenfeld; Tom van der Poll; Jean-Louis Vincent; Derek C Angus Journal: JAMA Date: 2016-02-23 Impact factor: 56.272
Authors: Belén Gutiérrez-Gutiérrez; Elena Salamanca; Marina de Cueto; Po-Ren Hsueh; Pierluigi Viale; José Ramón Paño-Pardo; Mario Venditti; Mario Tumbarello; George Daikos; Rafael Cantón; Yohei Doi; Felipe Francisco Tuon; Ilias Karaiskos; Elena Pérez-Nadales; Mitchell J Schwaber; Özlem Kurt Azap; Maria Souli; Emmanuel Roilides; Spyros Pournaras; Murat Akova; Federico Pérez; Joaquín Bermejo; Antonio Oliver; Manel Almela; Warren Lowman; Benito Almirante; Robert A Bonomo; Yehuda Carmeli; David L Paterson; Alvaro Pascual; Jesús Rodríguez-Baño Journal: Lancet Infect Dis Date: 2017-04-22 Impact factor: 25.071
Authors: Belén Gutiérrez-Gutiérrez; Elena Salamanca; Marina de Cueto; Po-Ren Hsueh; Pierluigi Viale; José Ramón Paño-Pardo; Mario Venditti; Mario Tumbarello; George Daikos; Vicente Pintado; Yohei Doi; Felipe Francisco Tuon; Ilias Karaiskos; Isabel Machuca; Mitchell J Schwaber; Özlem Kurt Azap; Maria Souli; Emmanuel Roilides; Spyros Pournaras; Murat Akova; Federico Pérez; Joaquín Bermejo; Antonio Oliver; Manel Almela; Warren Lowman; Benito Almirante; Robert A Bonomo; Yehuda Carmeli; David L Paterson; Alvaro Pascual; Jesús Rodríguez-Baño Journal: Mayo Clin Proc Date: 2016-10 Impact factor: 7.616
Authors: Elias Eger; Michael Schwabe; Lukas Schulig; Nils-Olaf Hübner; Jürgen A Bohnert; Uwe T Bornscheuer; Stefan E Heiden; Justus U Müller; Fazal Adnan; Karsten Becker; Carlos L Correa-Martinez; Sebastian Guenther; Evgeny A Idelevich; Daniel Baecker; Katharina Schaufler Journal: Microbiol Spectr Date: 2022-04-18