Infections caused by KPC-producing <i>Klebsiella pneumoniae</i>: differences in therapy and mortality in a multicentre study

Tumbarello, Mario; Trecarichi, Enrico Maria; Rosa, Francesco Giuseppe De; Giannella, Maddalena; Giacobbe, Daniele Roberto; Bassetti, Matteo; Losito, Angela Raffaella; Bartoletti, Michele; Bono, Valerio Del; Corcione, Silvia; Maiuro, G.; Tedeschi, Sara; Celani, Luigi; Cardellino, Chiara Simona; Spanu, Teresa; Marchese, Anna; Ambretti, Simone; Cauda, Roberto; Viscoli, Claudio; Viale, Pierluigi

doi:10.1093/jac/dkv086

Cited by 459 publications

(402 citation statements)

References 35 publications

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“…[53][54][55] These areas also report that alarmingly high proportions of Gram-negative bacteremias are due to CRE in this population. Multicenter studies from New York City and Italy have reported that CRE represent 5-6% of all Gram-negative bacteremias in patients with hematologic malignancies, 56,57 and single centers from Israel and Italy have reported that CRE represent 16-18% of Gram-negative bacteremias.…”

Section: Cre In Patients With Hematologic Malignancies and Haematopoimentioning

confidence: 80%

Carbapenem-resistant Enterobacteriaceae in special populations: Solid organ transplant recipients, stem cell transplant recipients, and patients with hematologic malignancies

2016

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Carbapenem-resistant Enterobacteriaceae (CRE) are a major global public health concern and pose a serious threat to immunocompromised hosts, particularly patients with hematologic malignancies and solid organ (SOT) and stem cell transplant recipients. In endemic areas, carbapenem-resistant Klebsiella pneumoniae infections occur in 1-18% of SOT recipients, and patients with hematologic malignancies represent 16-24% of all patients with CRE bacteremia. Mortality rates approaching 60% have been reported in these patient populations. Early diagnosis and rapid initiation of targeted therapy is critical in the management of immunocompromised hosts with CRE infections, as recommended empiric regimens are not active against CRE. Therapeutic options are limited by antibiotic-associated toxicities, interactions with immunosuppressive agents, and paucity of antibiotic options currently available. Prevention of CRE infection in these patients requires a multidisciplinary approach involving hospital epidemiology and antimicrobial stewardship. Large, multicenter studies are needed to develop risk-stratification tools to assist in guiding the management of these individuals.

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Section: Cre In Patients With Hematologic Malignancies and Haematopoimentioning

confidence: 80%

Carbapenem-resistant Enterobacteriaceae in special populations: Solid organ transplant recipients, stem cell transplant recipients, and patients with hematologic malignancies

2016

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“…Strains of K. pneumoniae and other Enterobacteriaceae harboring bla KPC are often extremely drug resistant and pose a significant therapeutic challenge. 1,2 Infections by these strains have also been associated with poor clinical outcomes. [3][4][5] Since they were originally reported in nosocomial outbreaks in the northeastern United States more than a decade ago, these strains have disseminated rapidly to become endemic pathogens in North America, and they are also widespread in Europe, Latin America, and Asia.…”

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confidence: 99%

Risk Factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Acquisition Among Contacts of Newly Diagnosed CP-CRE Patients

Schwartz-Neiderman

Braun

Fallach

et al. 2016

Infect. Control Hosp. Epidemiol.

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objective. Carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) are extremely drug-resistant pathogens. Screening of contacts of newly identified CP-CRE patients is an important step to limit further transmission. We aimed to determine the risk factors for CP-CRE acquisition among patients exposed to a CP-CRE index patient.methods. A matched case-control study was performed in a tertiary care hospital in Israel. The study population was comprised of patients who underwent rectal screening for CP-CRE following close contact with a newly identified CP-CRE index patient. Cases were defined as positive tests for CP-CRE. For each case patient, 2 matched controls were randomly selected from the pool of contacts who tested negative for CP-CRE following exposure to the same index case. Bivariate and multivariate analyses were conducted using conditional logistic regression.results. In total, 53 positive contacts were identified in 40 unique investigations (896 tests performed on 735 contacts) between October 6, 2008, and June 7, 2012. bla KPC was the only carbapenemase identified. In multivariate analysis, risk factors for CP-CRE acquisition among contacts were (1) contact with an index patient for ≥3 days (odds ratio [OR], 9.8; 95% confidence interval [CI], 2.0-48.9), (2) mechanical ventilation (OR, 4.1; 95% CI, 1.4-11.9), and (3) carriage or infection with another multidrug-resistant organism (MDRO; OR, 2.6; 95% CI, 1.0-7.1). Among patients who received antibiotics, cephalosporins were associated with a lower risk of acquisition.conclusions. Patient characteristics (ventilation and carriage of another MDRO) as well as duration of contact are risk factors for CP-CRE acquisition among contacts. The role of cephalosporins requires further study.

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“…The choice of empiric appropriate therapy, meaning appropriate and early therapy at pharmacokinetic/pharmacodynamic (PK/PD)-optimized doses and dose intervals, is currently complex. MDR microorganisms are increasing, and inappropriate empirical treatment has been described as an independent predictor of 14-day mortality (OR, 1.48; 95 % CI, 1.01-2.18) for infections caused by Klebsiella pneumoniae (Kp)-producing carbapenemase (KPC) [9]. Moreover, in critically ill patients physiological alterations may severely modify antibiotic exposure.…”

Section: Empiric Treatmentmentioning

confidence: 99%

Focus on antimicrobial use in the era of increasing antimicrobial resistance in ICU

2016

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Infections caused by KPC-producing Klebsiella pneumoniae: differences in therapy and mortality in a multicentre study

Abstract: KPC-Kp infections are associated with high mortality. Treatment with two or more drugs displaying activity against the isolate improves survival, mainly in patients who are critically ill.

Cited by 459 publications

References 35 publications

Carbapenem-resistant Enterobacteriaceae in special populations: Solid organ transplant recipients, stem cell transplant recipients, and patients with hematologic malignancies

Carbapenem-resistant Enterobacteriaceae in special populations: Solid organ transplant recipients, stem cell transplant recipients, and patients with hematologic malignancies

Risk Factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Acquisition Among Contacts of Newly Diagnosed CP-CRE Patients

Focus on antimicrobial use in the era of increasing antimicrobial resistance in ICU

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