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Mortality in KPC-producing Klebsiella pneumoniae bloodstream infections: a changing landscape.
- Source :
-
The Journal of antimicrobial chemotherapy [J Antimicrob Chemother] 2023 Oct 03; Vol. 78 (10), pp. 2505-2514. - Publication Year :
- 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.<br />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).<br />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 < 0.001) and Pitt score (HR 1.33; 95% CI 1.15-1.55, P < 0.001), but not carbapenem resistance (HR 1.28, 95% CI 0.74-2.22, P = 0.410). In a propensity score-matched analysis, there was no difference in mortality between patients appropriately treated with ceftazidime/avibactam for CR-Kp BSI and patients appropriately treated with other agents (mainly meropenem monotherapy or piperacillin/tazobactam monotherapy) for CS-Kp BSI (HR 1.07; 95% CI 0.50-2.29, P = 0.866).<br />Conclusions: Our results suggest that the increased mortality in CR-Kp BSI compared with CS-Kp BSI is not (or no longer) dependent on the type of therapy in areas where ceftazidime/avibactam-susceptible KPC-producing isolates are the most prevalent type of CR-Kp.<br /> (© The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Subjects :
- Humans
Ceftazidime pharmacology
Klebsiella pneumoniae
Retrospective Studies
Azabicyclo Compounds therapeutic use
Azabicyclo Compounds pharmacology
beta-Lactamases genetics
Bacterial Proteins genetics
Carbapenems pharmacology
Carbapenems therapeutic use
beta-Lactamase Inhibitors therapeutic use
Drug Combinations
Disease Susceptibility
Anti-Bacterial Agents pharmacology
Anti-Bacterial Agents therapeutic use
Klebsiella Infections drug therapy
Klebsiella Infections epidemiology
Bacteremia drug therapy
Sepsis drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1460-2091
- Volume :
- 78
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- The Journal of antimicrobial chemotherapy
- Publication Type :
- Academic Journal
- Accession number :
- 37606528
- Full Text :
- https://doi.org/10.1093/jac/dkad262