Carbapenemase-producing Klebsiella pneumoniae bloodstream infections in neutropenic patients with haematological malignancies or aplastic anaemia: Analysis of 50 cases

Tofas, Polydoros; Skiada, Anna; Angelopoulou, Maria K.; Sipsas, Nikolaos V.; Pavlopoulou, Ioanna; Tsaousi, S; Pagoni, Maria; Kotsopoulou, Maria; Perlorentzou, Stavroula; Antoniadou, Anastasia; Pirounaki, Maria; Skoutelis, Athanasios; Daikos, George L.

doi:10.1016/j.ijantimicag.2016.01.011

Cited by 66 publications

(86 citation statements)

References 18 publications

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“…Twenty-eight reported information on prevalence of carbapenem resistance among GNB; two articles did not analyse CR prevalence but reported data on factors and/or outcome associated with CR infections. 11,22 Additional characteristics of the included studies are reported in Appendix S4. Neutropenia was defined by the majority of studies as an absolute neutrophil count (ANC) below 500/mm 3 .…”

Section: Study Characteristicsmentioning

confidence: 99%

“…11,14,16,19,27,29,35,36,39 Haematological malignancies represented the main cause of neutropenia; seven studies included also patients with solid cancer (ranging from 5% to 44% of the patient population). Acute leukaemia was the most common haematological disease in 17 (57%) studies.…”

Section: 39mentioning

confidence: 99%

“…Antimicrobial susceptibility testing was documented according to the CLSI in 16 studies 12,14,17,18,22,23,25,28,[31][32][33][35][36][37][38]40 and according to EUCAST or to Swedish Reference Group for Antibiotics (SRGA) breakpoints in two studies, 11,21 while for the others the testing method was not documented. Only two reports performed molecular characterization of CR strains.…”

Section: 39mentioning

confidence: 99%

“…11,13,19,22 Data on the outcome of CR BSIs in neutropenic patients were reported by 10 studies. 11,13,[15][16][17]19,21,22,30,32 Mortality rates ranged from 33.3% to 71.4% (median rates 50%). One study reporting only carbapenemase-producing Kp (KPC-Kp) BSIs Only Pseudomonas spp.…”

mentioning

confidence: 99%

“…11 Six studies compared mortality in CR versus CS strains; 13,15,17,19,21,32 among these, one large study reported OR adjusted for confounders (e.g. demographic data, comorbidities, type of haematological disease).…”

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confidence: 99%

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Global prevalence of carbapenem resistance in neutropenic patients and association with mortality and carbapenem use: systematic review and meta-analysis

Righi

Peri

Harris

et al. 2016

J. Antimicrob. Chemother.

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Background: Carbapenem-resistant Gram-negative bacteria are recognized as a cause of difficult-to-treat infections associated with high mortality.Objectives: To perform a systematic review of currently available data on distribution, characteristics and outcome associated with carbapenem-resistant bloodstream infections in adult neutropenic patients.Methods: Included studies were identified through Medline, Embase and Cochrane databases between January 1995 and April 2016. Random effect meta-analysis was used to quantify the association between carbapenem resistance and mortality and between carbapenem exposure and resistance.Results: A total of 30 studies from 21 countries were included. Overall carbapenem resistance varied from 2% to 53% (median 9%) among studies. Infections due to carbapenem-resistant Pseudomonas spp. were reported in 18 (60%) studies showing high median resistance rates (44% of all carbapenem-resistant Gram-negatives and 19% of Pseudomonas isolates). Resistance of Enterobacteriaceae was less commonly reported and bloodstream infections due to carbapenem-resistant Klebsiella spp. were mainly documented from endemic areas (Greece, Italy, Israel). Carbapenem resistance in Acinetobacter spp. was reported in 9 (30%) studies (median resistance 58% of Acinetobacter isolates). Mortality rates ranged from 33% to 71% (median 50%) in patients with carbapenem-resistant infections. Carbapenem resistance appeared to correlate with mortality (OR 4.89,) and previous exposure to carbapenems (OR 4.63,.Conclusions: Carbapenem resistance represents a threat to neutropenic patients. In this group, resistance is likely promoted by previous carbapenem use and leads to high mortality rates. The knowledge of resistance patterns is crucial and can direct clinicians in the use of alternatives to carbapenem-based regimens.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: 39mentioning

confidence: 99%

Section: 39mentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Global prevalence of carbapenem resistance in neutropenic patients and association with mortality and carbapenem use: systematic review and meta-analysis

Righi

Peri

Harris

et al. 2016

J. Antimicrob. Chemother.

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Bloodstream infections caused by Klebsiella pneumoniae in onco‐hematological patients: clinical impact of carbapenem resistance in a multicentre prospective survey

et al. 2016

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The aim of this study was to identify risk factors for mortality in patients suffering from hematological malignancies (HMs) with bloodstream infections (BSIs) caused by Klebsiella pneumoniae (KP). We conducted a prospective cohort study on KP BSI in 13 Italian hematological units participating in the HEMABIS registry-SEIFEM group. The outcome measured was death within 21 days of BSI onset. Survivor and non-survivor subgroups were compared and Cox regression analysis was conducted to identify independent predictors of mortality. A total of 278 episodes of KP BSI were included in the study between January 2010 and June 2014. We found that 161 (57.9%) KP isolates were carbapenem resistant (CRKP). The overall 21-day mortality rate was 36.3%. It was significantly higher for patients with CRKP BSI (84/161, 52.2%) than for those with BSI caused by carbapenem susceptible KP (CSKP) (17/117, 14.5%; P < 0.001). Septic shock (HR 3.86), acute respiratory failure (HR 2.32), inadequate initial antimicrobial therapy (HR 1.87) and carbapenem resistance by KP isolates (HR 1.85) were independently associated with mortality. A subanalysis was conducted in only 149 patients with CRKP BSI who had received ≥48 hr of adequate antibiotic therapy, and combination therapy was independently associated with survival (HR 0.32). Our study shows that in recent years carbapenem resistance has dramatically increased in HM patients with KP BSI in Italy and is associated with a worse outcome. The optimal management of such infections and the definition of new empirical/targeted antimicrobial strategies in HM patients can still be considered unmet clinical needs. Am. J. Hematol. 91:1076-1081, 2016. © 2016 Wiley Periodicals, Inc.

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Bacteremia in Neutropenic Patients

Hernandez

Velez

Lamarche

et al. 2019

Infections in Neutropenic Cancer Patients

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Carbapenemase-producing Klebsiella pneumoniae bloodstream infections in neutropenic patients with haematological malignancies or aplastic anaemia: Analysis of 50 cases

Cited by 66 publications

References 18 publications

Global prevalence of carbapenem resistance in neutropenic patients and association with mortality and carbapenem use: systematic review and meta-analysis

Global prevalence of carbapenem resistance in neutropenic patients and association with mortality and carbapenem use: systematic review and meta-analysis

Bloodstream infections caused by Klebsiella pneumoniae in onco‐hematological patients: clinical impact of carbapenem resistance in a multicentre prospective survey

Bacteremia in Neutropenic Patients

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