Carbapenemase-producing Klebsiella pneumoniae bloodstream infection in critically ill patients: risk factors and predictors of mortality

Abstract

A significant increase in carbapenemase-producing Klebsiella pneumoniae (CP-Kp) bacteraemias has been observed worldwide. The objective of the present work was to study the risk factors and predictors of mortality of CP-Kp bacteraemias among critically ill patients. During a 4-year period (2012-3015), a matched 1:2 case-control study was conducted. Klebsiella pneumoniae was identified by Vitek 2 technology. Antibiotic susceptibility was performed by the agar disc diffusion method and Etest. The presence of the bla , bla and bla genes was confirmed by polymerase chain reaction (PCR). Epidemiologic data were collected from the intensive care unit (ICU) computerised database. One hundred and thirty-nine patients who developed a CP-Kp bacteraemia were matched with 278 patients. The majority of isolates (128; 92.1%) carried the bla gene, seven carried both bla and bla, three bla and one carried bla. Risk factors for the development of CP-Kp bacteraemia were administration of tigecycline and number of antibiotics administered prior to CP-Kp bacteraemia. Overall, the 30-day mortality was 36.0%. Multivariate analysis revealed septic shock, Simplified Acute Physiology Score II (SAPS II) upon infection onset, adjunctive corticosteroid administration and parenteral nutrition as independent predictors of mortality, while treatment with a combination of appropriate antibiotics was identified as a predictor of good prognosis. Among septic shock patients (n = 74), Sequential Organ Failure Assessment (SOFA) score upon infection onset, adjunctive corticosteroid administration and strain carrying the bla gene were independently associated with mortality, while the administration of combination treatment was identified as a predictor of a good prognosis. The administration of tigecycline predisposes to the induction of bacteraemia. Appropriate antibiotic treatment is associated with better survival, while concomitant corticosteroid treatment is associated with mortality.

Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae

“…Observational studies comparing the outcomes for patients treated with monotherapy or combination therapy were reviewed, and control for confounders was taken into account. Most studies focused on or supplied data for BSI (212)(213)(214)(215)(216)(217)(218)(219)(220)(221)(222)(223)(224)(225)(226)(227)(228)(229) (Table 4), while others included other types of infection (213,215,227,(230)(231)(232)(233)(234)(235)(236) (Table 5). Systematic reviews published in 2014 found major limitations in the studies analyzed and therefore could not draw strong conclusions (47,237).…”

“…The most frequent type of bacteria included were KPC-producing K. pneumoniae, although some studies included mainly OXA-48 producers (212,220,235), NDM producers (219), or noncarbapenemase producers (230). Some studies focused on specific populations, such as intensive care unit (ICU) patients (221,230), hematological or cancer patients (224, 225, 233), or children (219,232). As Tables 4 and 5 show, some studies found combination therapy to be associated with lower mortality rates, while others did not.…”

Epidemiological profile of healthcare-associated infections caused by Carbapenemase-producing Enterobacteriaceae

“…Carbapenemase-producing Enterobacteriaceae which carry the blaKPC gene (CPE-KPC) stand out among bacteria of epidemiological importance which present unrestrained growth in its resistance profile. These microorganisms spread rapidly and end up being associated with a high mortality rate by limiting the therapeutic options for infected patients (5,(7)(8) .…”

Epidemiology of nosocomial carbapenem-resistant Klebsiella pneumonia bloodstream infections in south China: factors related to the patient mortality

“…Overall, the rate of mortality in our patients with CRKP BSI was higher (65%) compared to the findings of previously studies [27]. Previous studies have evaluated several risk factors for the mortality associated with CRKP BSI, including use of corticosteroid, use of invasive devices, septic shock and exposure to carbapenems [27][28][29]. Fig-4 shows that CRKP BSI was related to gastrointestinal hemorrhage, Pitt bacteremia score, Charlton comorbidity index and Corticosteroids use and Septic shock.…”