Papadimitriou-Olivgeris M, Bartzavali C, Georgakopoulou A, Kolonitsiou F, Papamichail C, Spiliopoulou I, Christofidou M, Fligou F, Marangos M. Mortality of Pandrug-Resistant
Klebsiella pneumoniae Bloodstream Infections in Critically Ill Patients: A Retrospective Cohort of 115 Episodes.
Antibiotics (Basel) 2021;
10:antibiotics10010076. [PMID:
33467394 PMCID:
PMC7830393 DOI:
10.3390/antibiotics10010076]
[Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND
The increased frequency of bacteraemias caused by pandrug-resistant Klebsiella
pneumoniae (PDR-Kp) has significant implications. The aim of the present study was to identify predictors associated with mortality of PDR-Kp bacteraemias.
METHODS
Patients with monomicrobial bacteraemia due to PDR-Kp were included. K. pneumoniae was considered PDR if it showed resistance to all available groups of antibiotics. Primary outcome was 30-day mortality. Minimum inhibitory concentrations (MICs) of meropenem, tigecycline, fosfomycin, and ceftazidime/avibactam were determined by Etest, whereas for colistin, the broth microdilution method was applied. bla
KPC, bla
VIM, bla
NDM, and bla
OXA genes were detected by PCR.
RESULTS
Among 115 PDR-Kp bacteraemias, the majority of infections were primary bacteraemias (53; 46.1%), followed by catheter-related (35; 30.4%). All isolates were resistant to tested antimicrobials. bla
KPC was the most prevalent carbapenemase gene (98 isolates; 85.2%). Thirty-day mortality was 39.1%; among 51 patients with septic shock, 30-day mortality was 54.9%. Multivariate analysis identified the development of septic shock, Charlson comorbidity index, and bacteraemia other than primary or catheter-related as independent predictors of mortality, while a combination of at least three antimicrobials was identified as an independent predictor of survival.
CONCLUSIONS
Mortality of PDR-Kp bloodstream infections was high. Administration of at least three antimicrobials might be beneficial for infections in critically ill patients caused by such pathogens.
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