Infections caused by KPC-producing Klebsiella pneumoniae: differences in therapy and mortality in a multicentre study
Mario Tumbarello,Enrico Maria Trecarichi,Francesco Giuseppe De Rosa,Maddalena Giannella,Daniele Roberto Giacobbe,Matteo Bassetti,Angela Raffaella Losito,Michele Bartoletti,Valerio Del Bono,Silvia Corcione,G. Maiuro,Sara K. Tedeschi,Luigi Celani,Chiara Simona Cardellino,Teresa Spanu,Anna Marchese,Simone Ambretti,Roberto Cauda,Claudio Viscoli,Pierluigi Viale +19 more
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TLDR
KPC-Kp infections are associated with high mortality and treatment with two or more drugs displaying activity against the isolate improves survival, mainly in patients who are critically ill.Abstract:
Objectives Infections caused by Klebsiella pneumoniae (Kp) carbapenemase (KPC)-producing strains of Kp have become a significant threat in recent years. To assess their outcomes and identify risk factors for 14 day mortality, we conducted a 4 year (2010-13) retrospective cohort study in five large Italian teaching hospitals. Methods The cohort included 661 adults with bloodstream infections (BSIs; n = 447) or non-bacteraemic infections (lower respiratory tract, intra-abdominal structure, urinary tract or other sites) caused by a KPC-Kp isolate. All had received ≥48 h of therapy (empirical and/or non-empirical) with at least one drug to which the isolate was susceptible. Results Most deaths occurred within 2 weeks of infection onset (14 day mortality: 225/661, 34.1%). Logistic regression analysis identified BSI (OR, 2.09; 95% CI, 1.34-3.29), presentation with septic shock (OR, 2.45; 95% CI, 1.47-4.08), inadequate empirical antimicrobial therapy (OR, 1.48; 95% CI, 1.01-2.18), chronic renal failure (OR, 2.27; 95% CI, 1.44-3.58), high APACHE III score (OR, 1.05; 95% CI, 1.04-1.07) and colistin-resistant isolates (OR, 2.18; 95% CI, 1.37-3.46) as independent predictors of 14 day mortality. Combination therapy with at least two drugs displaying in vitro activity against the isolate was associated with lower mortality (OR, 0.52; 95% CI, 0.35-0.77), in particular in patients with BSIs, lung infections or high APACHE III scores and/or septic shock at infection onset. Combinations that included meropenem were associated with significantly higher survival rates when the KPC-Kp isolate had a meropenem MIC of ≤8 mg/L. Conclusions 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.read more
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Antimicrobial resistance in ESKAPE pathogens
David M. P. De Oliveira,Brian M. Forde,Timothy J. Kidd,Patrick N A Harris,Mark A. Schembri,Scott A. Beatson,David L. Paterson,Mark J. Walker +7 more
TL;DR: The acquisition of antimicrobial resistance genes by ESKAPE pathogens has reduced the treatment options for serious infections, increased the burden of disease, and increased death rates due to treatment failure and requires a coordinated global response for antim antibiotic resistance surveillance.
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David van Duin,Yohei Doi +1 more
TL;DR: Carbapenemase-producing Enterobacteriaceae have been most commonly associated with the Indian Subcontinent as well as with specific countries in Europe, including Romania, Denmark, Spain, and Hungary.
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Global Dissemination of Carbapenemase-Producing Klebsiella pneumoniae: Epidemiology, Genetic Context, Treatment Options, and Detection Methods
TL;DR: Although, combination therapy has been recommended for the treatment of severe carbapenemase-producing K. pneumoniae infections, the clinical evidence for this strategy is currently limited, and more accurate randomized controlled trials will be required to establish the most effective treatment regimen.
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Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae.
TL;DR: Overall, therapy of MDR-E infection must be individualized according to the susceptibility profile, type, and severity of infection and the features of the patient.
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Colistin Versus Ceftazidime-Avibactam in the Treatment of Infections Due to Carbapenem-Resistant Enterobacteriaceae
David van Duin,Judith J. Lok,Michelle Earley,Eric Cober,Sandra S. Richter,Federico Perez,Federico Perez,Robert A. Salata,Robert C. Kalayjian,Richard R. Watkins,Richard R. Watkins,Yohei Doi,Keith S Kaye,Vance G. Fowler,David L. Paterson,Robert A. Bonomo,Robert A. Bonomo,Scott R. Evans +17 more
TL;DR: Ceftazidime-avibactam may be a reasonable alternative to colistin in the treatment of K. pneumoniae carbapenemase-producing CRE infections and require confirmation in a randomized controlled trial.
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