Risk factors for bloodstream infections due to colistin-resistant KPC-producing Klebsiella pneumoniae: results from a multicenter case–control–control study

Abstract

The increasing prevalence of colistin resistance (ColR) Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (Kp) is a matter of concern because of its unfavourable impact on mortality of KPC-Kp bloodstream infections (BSI) and the shortage of alternative therapeutic options. A matched case-control-control analysis was conducted. The primary study end point was to assess risk factors for ColR KPC-Kp BSI. The secondary end point was to describe mortality and clinical characteristics of these infections. To assess risk factors for ColR, 142 patients with ColR KPC-Kp BSI were compared to two controls groups: 284 controls without infections caused by KPC-Kp (control group A) and 284 controls with colistin-susceptible (ColS) KPC-Kp BSI (control group B). In the first multivariate analysis (cases vs. group A), previous colistin therapy, previous KPC-Kp colonization, ≥3 previous hospitalizations, Charlson score ≥3 and neutropenia were found to be associated with the development of ColR KPC-Kp BSI. In the second multivariate analysis (cases vs. group B), only previous colistin therapy, previous KPC-Kp colonization and Charlson score ≥3 were associated with ColR. Overall, ColR among KPC-Kp blood isolates increased more than threefold during the 4.5-year study period, and 30-day mortality of ColR KPC-Kp BSI was as high as 51%. Strict rules for the use of colistin are mandatory to staunch the dissemination of ColR in KPC-Kp-endemic hospitals.

Bloodstream infections in neutropenic cancer patients: A practical update

“…55 The association between colonization and subsequent infection has been reported for many MDR bacteria, such as VRE, ESBL-producing Enterobacteriaceae, P. aeruginosa, S. maltophilia and carbapenem or colistin resistant K. pneumoniae. 115,116 Therefore, decolonization before the onset of neutropenia seems appealing in case of carbapenem-resistant bacteria, but very few data on the efficacy of this approach exist in this setting. For this purpose, oral gentamycin or a combination of oral gentamycin and colistin were used, with eradication rate of 40-50%, which was higher than the spontaneous eradication rate, but tended to decrease after few weeks.…”

Epidemiology of antimicrobial resistance in bloodstream infections

“…108 A very recent multicenter study from the same country reported that during a 4.5 y period, the colistin resistance increased >3-fold in participating centers and related with a mortality rate of 51%. 109 Pseudomonas aeruginosa In Europe, P. aeruginosa strains with high resistance rates to aminoglycosides, ceftazidime, quinolones, piperacillin-tazobactam and carbapenems are usually reported from Southern and Eastern part of the continent. 9 However, ECDC reported that a trend analysis for 2009 to 2012 indicated a stable resistance pattern for these antimicrobials.…”

Factors Associated with Nosocomial Bloodstream Infection Caused by Carbapenem-Resistant Klebsiella pneumoniae and With Mortality, from a Single Center

“…The other study of 13 Italian hematological units reported a rate of CRKP that increased significantly from 21.4% in 2010 to 75.9% in 2013 [6]. Neutropenia, HM and chemotherapy/radiation therapy have been recognized as independent risk factors of CRKP infection [7][8][9].…”