Mortality in KPC-producing Klebsiella pneumoniae bloodstream infections: a changing landscape

Abstract Objectives To assess the impact of carbapenem resistance on mortality in Klebsiella pneumoniae bloodstream infection (BSI) in the era of novel β-lactam/β-lactamase inhibitor combinations. Material and methods Retrospective study of patients with K. pneumoniae BSI between January and August...

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Published in:Journal of antimicrobial chemotherapy 2023-10, Vol.78 (10), p.2505-2514
Main Authors: Giacobbe, Daniele Roberto, Marelli, Cristina, Cattardico, Greta, Fanelli, Chiara, Signori, Alessio, Di Meco, Gabriele, Di Pilato, Vincenzo, Mikulska, Malgorzata, Mazzitelli, Maria, Cattelan, Anna Maria, Pallotto, Carlo, Francisci, Daniela, Calabresi, Alessandra, Lombardi, Andrea, Gori, Andrea, Del Bono, Valerio, Aldieri, Chiara, Losito, Angela Raffaella, Raffaelli, Francesca, Cortegiani, Andrea, Milazzo, Marta, Del Puente, Filippo, Pontali, Emanuele, De Rosa, Francesco Giuseppe, Corcione, Silvia, Mularoni, Alessandra, Russelli, Giovanna, Giacomini, Mauro, Badalucco Ciotta, Flavia, Oltolini, Chiara, Serino, Francesco Saverio, Momesso, Elena, Spinicci, Michele, Graziani, Lucia, Torti, Carlo, Trecarichi, Enrico Maria, Merli, Marco, D’Amico, Federico, Marchese, Anna, Vena, Antonio, Bassetti, Matteo
Format: Article
Language:English
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Summary:Abstract Objectives To assess the impact of carbapenem resistance on mortality in Klebsiella pneumoniae bloodstream infection (BSI) in the era of novel β-lactam/β-lactamase inhibitor combinations. Material and methods Retrospective study of patients with K. pneumoniae BSI between January and August 2020 in 16 centres (CARBANEW study within the MULTI-SITA project). Results Overall, 426 patients were included: 107/426 (25%) had carbapenem-resistant K. pneumoniae (CR-Kp) BSI and 319/426 (75%) had carbapenem-susceptible K. pneumoniae (CS-Kp) BSI. Crude cumulative 30 day mortality was 33.8% and 20.7% in patients with, respectively, CR-Kp BSI and CS-Kp BSI (P = 0.027). Carbapenemase production or carbapenemase-encoding genes were detected in 84/98 tested CR-Kp isolates (85.7%), mainly KPC (78/84; 92.9%). Ceftazidime/avibactam was the most frequently used appropriate therapy for CR-Kp BSI (80/107; 74.7%). In multivariable analyses, variables showing an unfavourable association with mortality after correction for multiple testing were age-adjusted Charlson comorbidity index (HR 1.20; 95% CI 1.10–1.31, P 
ISSN:0305-7453
1460-2091
DOI:10.1093/jac/dkad262