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TERESA MARIA ASSUNTA FASCIANA

Mortality in KPC-producing Klebsiella pneumoniae bloodstream infections: a changing landscape

  • Authors: Giacobbe, Daniele Roberto; Marelli, Cristina; Cattardico, Greta; Fanelli, Chiara; Signori, Alessio; Di Meco, Gabriele; Di Pilato, Vincenzo; Mikulska, Malgorzata; Mazzitelli, Maria; Cattelan, Anna Maria; Pallotto, Carlo; Francisci, Daniela; Calabresi, Alessandra; Lombardi, Andrea; Gori, Andrea; Del Bono, Valerio; Aldieri, Chiara; Losito, Angela Raffaella; Raffaelli, Francesca; Cortegiani, Andrea; Milazzo, Marta; Del Puente, Filippo; Pontali, Emanuele; De Rosa, Francesco Giuseppe; Corcione, Silvia; Mularoni, Alessandra; Russelli, Giovanna; Giacomini, Mauro; Badalucco Ciotta, Flavia; Oltolini, Chiara; Serino, Francesco Saverio; Momesso, Elena; Spinicci, Michele; Graziani, Lucia; Torti, Carlo; Trecarichi, Enrico Maria; Merli, Marco; D'Amico, Federico; Marchese, Anna; Vena, Antonio; Bassetti, Matteo;Paola Stano, Vincenzo Scaglione, Sara Benedetti, Antonella Mencacci, Alessandra Bandera, Giulia Viero, Paola Del Giacomo, Teresa Fasciana, Gabriele Presti, Andrea Parisini, Elisabetta Blasi Vacca, Nour Shbaklo, Ilaria De Benedetto, Marco Ripa, Antonella Castagna, Nicoletta Boffa, Elena Potenza, Alessandro Bartoloni, Tommaso Giani, Alessandro Russo, Francesca Serapide, Giulia Viglietti, Giovanna Travi, Carlotta Rogati, Giulia Codda
  • Publication year: 2023
  • Type: Articolo in rivista
  • OA Link: http://hdl.handle.net/10447/605533

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. 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). 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). 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.