Background Infections caused by KPC-producing Klebsiella pneumoniae (Kp) are associated with high mortality. Therefore, new treatment options are urgently required. Objectives To assess the outcomes and predictors of mortality in patients with KPC- or OXA-48-Kp infections treated with ceftazidime/avibactam with an emphasis on KPC-Kp bloodstream infections (BSIs). Methods A multicentre prospective observational study was conducted between January 2018 and March 2019. Patients with KPC- or OXA-48-Kp infections treated with ceftazidime/avibactam were included in the analysis. The subgroup of patients with KPC-Kp BSIs treated with ceftazidime/avibactam was matched by propensity score with a cohort of patients whose KPC-Kp BSIs had been treated with agents other than ceftazidime/avibactam with in vitro activity. Results One hundred and forty-seven patients were identified; 140 were infected with KPC producers and 7 with OXA-48 producers. For targeted therapy, 68 (46.3%) patients received monotherapy with ceftazidime/avibactam and 79 (53.7%) patients received ceftazidime/avibactam in combination with at least another active agent. The 14 and 28 day mortality rates were 9% and 20%, respectively. The 28 day mortality among the 71 patients with KPC-Kp BSIs treated with ceftazidime/avibactam was significantly lower than that observed in the 71 matched patients, whose KPC-Kp BSIs had been treated with agents other than ceftazidime/avibactam (18.3% versus 40.8%; P = 0.005). In the Cox proportional hazards model, ultimately fatal disease, rapidly fatal disease and Charlson comorbidity index ≥2 were independent predictors of death, whereas treatment with ceftazidime/avibactam-containing regimens was the only independent predictor of survival. Conclusions Ceftazidime/avibactam appears to be an effective treatment against serious infections caused by KPC-Kp.
INTRODUCTION Mechanically ventilated critically ill patients with acute COPD exacerbation (AECOPD) have significantly higher rates of morbidity and mortality compared to patients hospitalized for AECOPD but not requiring ventilatory support. The aim of this study was to describe the characteristics and outcomes of ventilated critically ill AECOPD patients and to identify prognostic variables associated with 28-day ICU mortality. METHODS One hundred and twenty-seven patients admitted to the University respiratory ICU in 'Sotiria' Hospital due to AECOPD were retrospectively studied. Data were extracted from the medical records of the ICU database. Demographic features, comorbidities, disease severity, exacerbation rate, and treatment, were recorded along with SOFA and APACHE-II scores and laboratory variables. RESULTS Thirty-five percent of the patients died in the ICU (mean age 73±8 vs 67±8 years in survivors, p<0.001). Non-survivors had significantly more comorbidities compared to survivors (p<0.001), significantly higher APACHE II score (30±7 vs 22±7, p<0.001), and significantly higher rates of multi-organ failure (MOF) (62% vs 10.2%, p<0.001). Independent factors associated with ICU mortality were older age (OR=1.13 per year increase; 95% CI: 1.04-1.22, p=0.004), APACHE II score on admission (OR=1.11 per unit increase; 95% CI: 1.04-1.22, p=0.004), Charlson Comorbidity Index (CCI) (OR=1.79 per unit increase; 95% CI: 1.25-2.55, p=0.001), admission lactate levels (OR=2.60 per mEq/L increase; 95% CI: 1.17-5.80, p=0.019), and COPD severity (OR=4.57; 95% CI: 1.14-18.22, p=0.032). CONCLUSIONS Severe physiological derangement upon ICU admission, COPD disease severity and high co-morbidity burden are predictive factors of 28-day mortality in critically ill AECOPD patients.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.