Risk factors for infection and predictors of mortality among patients with KPC-producing Klebsiella pneumoniae bloodstream infections in the intensive care unit

Papadimitriou-Olivgeris, Matthaios; Marangos, Markos; Christofidou, Myrto; Fligou, Fotini; Bartzavali, Christina; Panteli, Eleftheria S; Vamvakopoulou, Sophia; Filos, Kriton S.; Anastassiou, Evangelos D.

doi:10.3109/00365548.2014.923106

Cited by 59 publications

(58 citation statements)

References 23 publications

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“…Strikingly, a 4-fold difference in the number of carriers compared to noncarriers acquiring HAP due to K. pneumoniae was observed following a hospital stay of more than 3 weeks (127). As previously noted, antibiotic treatment amplifies the risk of K. pneumoniae infection, and recent antibiotic use is an additional independent risk factor for colonization by and infections with ESBL-and carbapenemase-producing K. pneumoniae (128)(129)(130)(131).…”

Section: Patient Risk Factorsmentioning

confidence: 59%

Klebsiella pneumoniae: Going on the Offense with a Strong Defense

Paczosa

Mecsas

2016

Microbiol Mol Biol Rev

1,289

1,345

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SUMMARYKlebsiella pneumoniaecauses a wide range of infections, including pneumonias, urinary tract infections, bacteremias, and liver abscesses. Historically,K. pneumoniaehas caused serious infection primarily in immunocompromised individuals, but the recent emergence and spread of hypervirulent strains have broadened the number of people susceptible to infections to include those who are healthy and immunosufficient. Furthermore,K. pneumoniaestrains have become increasingly resistant to antibiotics, rendering infection by these strains very challenging to treat. The emergence of hypervirulent and antibiotic-resistant strains has driven a number of recent studies. Work has described the worldwide spread of one drug-resistant strain and a host defense axis, interleukin-17 (IL-17), that is important for controlling infection. Four factors, capsule, lipopolysaccharide, fimbriae, and siderophores, have been well studied and are important for virulence in at least one infection model. Several other factors have been less well characterized but are also important in at least one infection model. However, there is a significant amount of heterogeneity inK. pneumoniaestrains, and not every factor plays the same critical role in all virulentKlebsiellastrains. Recent studies have identified additionalK. pneumoniaevirulence factors and led to more insights about factors important for the growth of this pathogen at a variety of tissue sites. Many of these genes encode proteins that function in metabolism and the regulation of transcription. However, much work is left to be done in characterizing these newly discovered factors, understanding how infections differ between healthy and immunocompromised patients, and identifying attractive bacterial or host targets for treating these infections.

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Section: Patient Risk Factorsmentioning

confidence: 59%

Klebsiella pneumoniae: Going on the Offense with a Strong Defense

Paczosa

Mecsas

2016

Microbiol Mol Biol Rev

1,289

1,345

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“…To the best of our knowledge, two case series with a low number of cases have been reported. Sbrana et al showed a high clinical response rate (92%) in 22 polytrauma patients (19), and Papadimitriou-Olivgeris et al (20) observed a 43.4% mortality in 53 patients. The mortality rate observed in combination regimens not including carbapenems found in this study (25%) is more similar to that reported in the literature for strains with low resistance when regimens including carbapenems were used (4, 6, 10).…”

Section: Discussionmentioning

confidence: 98%

Mortality Associated with Bacteremia Due to Colistin-Resistant Klebsiella pneumoniae with High-Level Meropenem Resistance: Importance of Combination Therapy without Colistin and Carbapenems

Machuca

Gutiérrez‐Gutiérrez

Gracia-Ahufinger

et al. 2017

Antimicrob Agents Chemother

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Combination therapy including colistin and a carbapenem has been found to be associated with lower mortality in the treatment of bloodstream infections (BSI) due to KPC-producing Klebsiella pneumoniae when the isolates show a meropenem or imipenem MIC of Ͻ16 mg/liter. However, the optimal treatment of BSI caused by colistin-and high-level carbapenem-resistant KPC-producing K. pneumoniae is unknown. A prospective cohort study including episodes of bacteremia caused by colistin-resistant and high-level meropenem-resistant (MIC Ն 64 mg/liter) KPC-producing K. pneumoniae diagnosed from July 2012 to February 2016 was performed. The impact of combination therapy on crude 30-day mortality was analyzed by Cox regression using a propensity score as a covariate to control for indication bias and in an inverse probability of treatment weighting (IPTW) cohort. The study sample comprised 104 patients, of which 32 (30.8%) received targeted monotherapy and 72 (69.2%) received targeted combination therapy; none of them received either colistin or a carbapenem. The 30-day crude mortality rate was 30.8% (43.8% in patients treated with monotherapy and 25% in patients receiving combination therapy). In the Cox regression analysis, 30-day mortality was independently associated with septic shock at BSI onset (hazard ratio [HR], 6.03; 95% confidence interval [CI], 1.65 to 21.9; P ϭ 0.006) and admission to the critical care unit (HR, 2.87; 95% CI, 0.99 to 8.27; P ϭ 0.05). Targeted combination therapy was associated with lower mortality only in patients with septic shock (HR, 0.14; 95% CI, 0.03 to 0.67; P ϭ 0.01). These results were confirmed in the Cox regression analysis of the IPTW cohort. Combination therapy is associated with reduced mortality in patients with bacteremia due to colistin-resistant KPC-producing K. pneumoniae with high-level carbapenem resistance in patients with septic shock.

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“…In eight studies patients infected with a MDR strain were compared to those with a susceptible one or to those without any infection. Comparative data on the appropriateness of empirical antibiotic treatment were provided by only seven [48,50,51,52,54,55] out of twenty-four studies.…”

Section: General Commentsmentioning

confidence: 99%

“…Zilberberg et al [50] Single center retrospective cohort study 1076 BSI Variable gram-negative/Paeruginosa resistant to at least 3 antimicrobials, ESBL, CPE Impact of MDR on inappropriate therapy/indirect effect on increased hospital mortality Shorr et al [51] Retrospective cohort study 131 BSI A. baumannii/carbapenem resistance Impact of carbapenem resistance on inappropriate therapy/indirect effect on mortality PapadimitriouOlivgeris et al [52] Single center study 273 Variable infections K. pneumoniae/resistance to gentamicin, colistin and/or tigecycline Positive association with mortality…”

Section: Bsi a Baumannii/carbapenem Resistance No Association With Mmentioning

confidence: 99%

Association between infections caused by multidrug-resistant gram-negative bacteria and mortality in critically ill patients

Paramythiotou

Routsi

2016

WJCCM

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The incidence of gram-negative multidrug-resistant (MDR) bacterial pathogens is increasing in hospitals and particularly in the intensive care unit (ICU) setting. The clinical consequences of infections caused by MDR pathogens remain controversial. The purpose of this review is to summarize the available data concerning the impact of these infections on mortality in ICU patients. Twenty-four studies, conducted exclusively in ICU patients, were identified through PubMed search over the years 2000-2015. Bloodstream infection was the only infection examined in eight studies, respiratory infections in four and variable infections in others. Comparative data on the appropriateness of empirical antibiotic treatment were provided by only seven studies. In ten studies the presence of antimicrobial resistance was not associated with increased mortality; on the contrary, in other studies a significant impact of antibiotic resistance on mortality was found, though, sometimes, mediated by inappropriate antimicrobial treatment. Therefore, a direct association between infections due to gram-negative MDR bacteria and mortality in ICU patients cannot be confirmed. Sample size, presence of multiple confounders and other methodological issues may influence the results. These data support the need for further studies to elucidate the real impact of infections caused by resistant bacteria in ICU patients.

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Risk factors for infection and predictors of mortality among patients with KPC-producing Klebsiella pneumoniae bloodstream infections in the intensive care unit

Abstract: Many risk factors are involved in KPC-Kp BSI among ICU patients. The high mortality in patients with KPC-KP BSI in the ICU requires the implementation of appropriate infection control measures.

Cited by 59 publications

References 23 publications

Klebsiella pneumoniae: Going on the Offense with a Strong Defense

Klebsiella pneumoniae: Going on the Offense with a Strong Defense

Mortality Associated with Bacteremia Due to Colistin-Resistant Klebsiella pneumoniae with High-Level Meropenem Resistance: Importance of Combination Therapy without Colistin and Carbapenems

Association between infections caused by multidrug-resistant gram-negative bacteria and mortality in critically ill patients

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