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Pagani N, Corcione S, Lupia T, Scabini S, Filippini C, Angilletta R, Shbaklo N, Mornese Pinna S, Romagnoli R, Biancone L, Cavallo R, Di Perri G, Solidoro P, Boffini M, De Rosa FG. Carbapenemase-Producing Klebsiella pneumoniae Colonization and Infection in Solid Organ Transplant Recipients: A Single-Center, Retrospective Study. Microorganisms 2021; 9:microorganisms9112272. [PMID: 34835398 PMCID: PMC8626028 DOI: 10.3390/microorganisms9112272] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/23/2021] [Accepted: 10/25/2021] [Indexed: 12/29/2022] Open
Abstract
Carbapenemase-KPC producing Klebsiella pneumoniae (CP-Kp) infection represents a serious threat to solid organ transplant (SOT). All patients admitted between 1 May 2011 and 31 August 2014 undergoing SOT were included in the retrospective study. The primary outcomes included a description of the association of enteric colonization and invasive infections by CP-Kp with one-year mortality. Secondary outcomes were the study of risk factors for colonization and invasive infections by CP-Kp. Results: A total of 5.4% (45/828) of SOT recipients had at least one positive rectal swab for CP-Kp, with most (88.9%) occurring after transplantation. 4.5% (35/828) of patients developed a CP-Kp-related invasive infection, with 68.6% (24/35) being previously colonized. The 1-year mortality was 31.1% in patients with enteric colonization with CP-Kp and, it was 51.4% among patients with CP-Kp-related invasive infections. At univariate analysis, colonization, invasive infections, sepsis, severe sepsis, and septic shock were significantly associated with 1-year mortality. At multivariate analysis, only invasive infections and the combination of sepsis, severe sepsis, or septic shock were significantly associated with 1-year mortality, whereas gastrointestinal colonization was significantly associated with survival. In this population, the 1-year mortality was significantly associated with invasive infections; otherwise, gastrointestinal colonization was not associated with increased 1-year mortality.
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Affiliation(s)
- Nicole Pagani
- St Stephen’s Centre, Chelsea and Westminster Hospital, 252 Fulham Rd., London SW10 9NA, UK; (N.P.); (G.D.P.)
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10100 Turin, Italy; (S.C.); (S.S.); (R.A.); (N.S.); (S.M.P.); (F.G.D.R.)
- Department of Medical Sciences, Tufts University School of Medicine, Boston, MA 02109, USA
| | - Tommaso Lupia
- Infectious Disease Unit, Cardinal Massaia Hospital, 14100 Asti, Italy
- Correspondence: ; Tel.: +39-014-148-6404
| | - Silvia Scabini
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10100 Turin, Italy; (S.C.); (S.S.); (R.A.); (N.S.); (S.M.P.); (F.G.D.R.)
| | - Claudia Filippini
- Clinical Statistics, Department of Surgical Sciences, University of Torino, 10126 Torino, Italy;
| | - Roberto Angilletta
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10100 Turin, Italy; (S.C.); (S.S.); (R.A.); (N.S.); (S.M.P.); (F.G.D.R.)
| | - Nour Shbaklo
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10100 Turin, Italy; (S.C.); (S.S.); (R.A.); (N.S.); (S.M.P.); (F.G.D.R.)
| | - Simone Mornese Pinna
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10100 Turin, Italy; (S.C.); (S.S.); (R.A.); (N.S.); (S.M.P.); (F.G.D.R.)
| | - Renato Romagnoli
- General Surgery 2U, Liver Transplant Center, AOU Città Della Salute e Della Scienza di Torino, University of Turin, 10100 Turin, Italy;
| | - Luigi Biancone
- S.C. Nefrologia, Dialisi e Trapianto U, AOU Città Della Salute e Della Scienza, 10100 Turin, Italy;
| | - Rossana Cavallo
- Microbiology and Virology Unit, University of Turin, 10100 Turin, Italy;
| | - Giovanni Di Perri
- St Stephen’s Centre, Chelsea and Westminster Hospital, 252 Fulham Rd., London SW10 9NA, UK; (N.P.); (G.D.P.)
| | - Paolo Solidoro
- Cardiovascular and Thoracic Department, Pneumology Unit U, AOU Città Della Salute e Della Scienza di Torino, 10100 Turin, Italy;
| | - Massimo Boffini
- Division of Cardiac Surgery, Department of Surgical Sciences, Città Della Salute e Della Scienza, University of Turin, 10100 Turin, Italy;
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10100 Turin, Italy; (S.C.); (S.S.); (R.A.); (N.S.); (S.M.P.); (F.G.D.R.)
- Infectious Disease Unit, Cardinal Massaia Hospital, 14100 Asti, Italy
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Lupia T, Stroffolini G, Angilletta R, Bonora S, Perri GD. Good times, bad times: A diary of a physician in the COVID-19 era. Eur J Intern Med 2020; 77:132-133. [PMID: 32418707 PMCID: PMC7227561 DOI: 10.1016/j.ejim.2020.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/03/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Tommaso Lupia
- Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy.
| | - Giacomo Stroffolini
- Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Roberto Angilletta
- Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Stefano Bonora
- Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giovanni Di Perri
- Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
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Scabini S, Lupia T, Angilletta R, De Rosa FG, Corcione S. Real-life use of isavuconazole outside the hematological wards. Eur J Intern Med 2019; 70:e10-e12. [PMID: 31526649 DOI: 10.1016/j.ejim.2019.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 09/09/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Silvia Scabini
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Tommaso Lupia
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy.
| | - Roberto Angilletta
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | | | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
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Corcione S, Segala FV, Castiglione A, Lupia T, Angilletta R, Cavallo R, Ciccone G, De Rosa FG. Enteropathogenetic nosocomial infections: predisposing clinical characteristics and risk of recurrent infections. J Chemother 2019; 31:394-400. [PMID: 31556352 DOI: 10.1080/1120009x.2019.1669275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Nosocomial infections caused by Clostridium difficile, CP-Kp, ESBL-E or Candida spp. are usually associated with a high mortality rate. In this retrospective study, we evaluated the association between the patient characteristics and the risk of development of nosocomial BSI due to Candida or CP-Kp or ESBL-E. Moreover, we described the cumulative incidence of recurrent infections according to each group of nosocomial BSI. Enteral or parenteral nutrition and indwelling CVC at time of diagnosis were associated with an increased risk of candidemia or CP-Kp over ESBL-E and CDI. ESBL-E BSI was higher in patients undergoing hemodialysis, hematological stem cell transplant and neutropenic patients. The cumulative incidence for recurrent infections was higher for CP-Kp BSI and lower for candidemia. Our data highlight a different role of single patient comorbidities in the development of infections and the higher incidence of recurrent infections in CP-Kp BSI.
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Affiliation(s)
- Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | | | - Anna Castiglione
- Unit of Clinical Epidemiology, Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
| | - Tommaso Lupia
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Roberto Angilletta
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Rossana Cavallo
- Department of Public Health and Pediatrics, University of Turin, Laboratory of Microbiology and Virology, Turin, Italy
| | - Giovannino Ciccone
- Unit of Clinical Epidemiology, Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
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Corcione S, Angilletta R, Raviolo S, Filippini C, Fossati L, Di Perri G, Cavallo R, De Rosa FG. Epidemiology and risk factors for mortality in bloodstream infection by CP-Kp, ESBL-E, Candida and CDI: A single center retrospective study. Eur J Intern Med 2018; 48:44-49. [PMID: 29096992 DOI: 10.1016/j.ejim.2017.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/16/2017] [Accepted: 10/21/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND The incidence of C. difficile infection (CDI) and of bloodstream infection (BSI) caused by Candida spp., ESBL-E-producing Enterobacteriaceae (ESBL-E) and carbapenemase-producing K. pneumoniae (CP-Kp) is associated with high mortality. METHODS We conducted a single centre retrospective study on patients admitted to Molinette Hospital, Turin, Italy, from January 2013 to April 2015 with CDI or BSI caused by Candida, ESBL-E or CP-Kp. For each patient demographic, clinical and microbiological data were collected. Aims of this study were to describe epidemiology and to evaluate risk factors for in-hospital mortality in this group of patients. RESULTS Seven hundred-eighty six cases were analyzed: 398 CDI, 137 candidemia, 125 ESBL-E BSI and 126 CP-Kp BSI. CDI, candidemia and ESBL-E BSI were more frequently reported in internal medicine wards (IMW), whilst CP-Kp were more described in intensive care unit (ICU). Sixty-six percent of patients had a previous hospitalization and the majority of patients had several medical comorbidities. In-hospital death occurred in 23.4%. Independent risk factors for mortality were antibiotic therapy before hospital admission, cardiovascular diseases, neutropenia, urinary catheter, total parenteral nutrition, SIRS and higher creatinine levels at diagnosis. Previous abdominal surgery, inflammatory bowel disease, higher serum albumin levels at the admission and fever at diagnosis were significantly associated with survival. CONCLUSION Our data showed that CDI, ESBL-E BSI and candidemia are more frequent in frail patients, admitted to IMW, with chronic comorbidities and broad exposure to antibiotic therapies, with the exception for CP-Kp BSI, still more common in the ICU.
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Affiliation(s)
- Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy.
| | - Roberto Angilletta
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Stefania Raviolo
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Claudia Filippini
- Department of Anesthesia and Intensive Care Medicine, University of Turin, City of Health and Sciences, Molinette Hospital, Turin, Italy
| | - Lucina Fossati
- Laboratory of Microbiology and Virology, City of Health and Sciences, Molinette Hospital, Turin, Italy
| | - Giovanni Di Perri
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Rossana Cavallo
- Department of Public Health and Pediatrics, University of Turin, Laboratory of Microbiology and Virology, Turin, Italy
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