Impact of KPC Production and High-Level Meropenem Resistance on All-Cause Mortality of Ventilator-Associated Pneumonia in Association with Klebsiella pneumoniae

Abstract

Carbapenemase-producing Enterobacterales and specifically Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KPC-Kp) are rapidly spreading worldwide. The prognosis of ventilator-associated pneumonia (VAP) caused by KPC-Kp is not well known. Our study tries to assess whether ventilator-associated pneumonia caused by a KPC-Kp strain is associated with higher all-cause mortality than that caused by carbapenem-susceptible isolates. This is a retrospective cohort study of patients with VAP due to K. pneumoniae from a 35-bed polyvalent intensive care unit in a university hospital (>40,000 annual admissions) between January 2012 and December 2016. Adjusted multivariate analysis was used to study the association of KPC-Kp with 30-day all-cause mortality (Cox regression). We analyze 69 cases of K. pneumoniae VAP, of which 39 were produced by a KPC-Kp strain with high-level resistance to meropenem (MIC > 16 mg/ml). All-cause mortality at 30 days was 41% in the KPC-Kp group (16/39) and 33.3% in the carbapenem-susceptible cases (10/30). KPC-Kp etiology was not associated with higher mortality when controlled for confounders (adjusted hazard ratio [HR], 1.25; 95% confidence interval [CI], 0.46 to 3.41). Adequate targeted therapy (HR, 0.03; 95% CI, <0.01 to 0.23) was associated with all-cause mortality. Assuming the limitations due to the available sample size, the prognosis of VAP caused by KPC-Kp is similar to VAPs caused by carbapenem-susceptible K. pneumoniae when appropriate treatment is used.

Colonization Dynamics of Multidrug-Resistant Klebsiella pneumoniae Are Dictated by Microbiota-Cluster Group Behavior over Individual Antibiotic Susceptibility: A Metataxonomic Analysis

“…These bacteria (i.e., ESBL-producers and carbapenemase-producing Enterobacterales (CRE)) present a considerable clinical problem, as the useful therapeutic armamentarium in these infections is very limited [ 4 , 5 , 6 ]. Many studies highlighted that infections caused by these pathogens are associated with high morbidity and mortality, and decreased quality of life in the affected patients, especially in vulnerable populations, such as pediatric patients, the elderly, the chronically ill, hospitalized patients, transplant recipients, and the immunosuppressed [ 7 , 8 , 9 , 10 ]. Unfortunately, resistance rates of these highly dangerous pathogens are on the rise both in hospital and community settings, particularly in Asian countries [ 2 , 11 , 12 , 13 , 14 ].…”

Preventative treatment with Fluorothiazinon suppressed Acinetobacter baumannii-associated septicemia in mice

“…The problem of ineffective treatment for nosocomial infections caused by multi-resistant bacteria, such as A. baumannii, P. aeruginosa, and K. pneumoniae, often leads to serious consequences, including the development of sepsis [12,13]. The complex therapy of patients infected with these bacteria includes different classes of antibiotics and anti-inflammatory drugs, but mortality, especially in ICUs, is very high [14,15].…”

Estimation of the Difference in Colistin Plasma Levels in Critically Ill Patients with Favorable or Unfavorable Clinical Outcomes

“…Although this study was not designed to find these differences, these findings are supported by other researchers. Rivera et al found that the isolation of carbapenemase-producing Klebsiella pneumoniae is not considered a risk factor for mortality; however, they documented that this species may have high resistance to carbapenems in certain cases, which may explain the increased mortality in some patients [55]. Pardo et al showed that the isolation of carbapenemase-producing Klebsiella pneumoniae and infection sites, especially respiratory tract or bloodstream infections, are related to higher mortality in patients with carbapenemase-producing Enterobacteriaceae infections [56].…”