Bacteremia caused by carbapenemase-producing and carbapenems-susceptible Klebsiella pneumoniae: clinical outcome, impact of COVID-19 and efficacy of ceftazidime/avibactam
Bacteremia caused by carbapenemase-producing Klebsiella pneumoniae (CP-KPN-B) are a serious complication in hospitalized patients due to high morbidity and mortality rates and multi-resistance to antibiotics. There are very few studies comparing CP-KPN-B and those caused by carbape...
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| Formato: | Artículo revista |
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2022
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| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/39101 |
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I10-R327-article-39101 |
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ojs |
| institution |
Universidad Nacional de Córdoba |
| institution_str |
I-10 |
| repository_str |
R-327 |
| container_title_str |
Revista de la Facultad de Ciencias Médicas de Córdoba |
| format |
Artículo revista |
| topic |
bacteremia klebsiella pneumoniae carbapenemases enterobacterales bacteriemia klebsiella pneumoniae carbapenemasas enterobacterales |
| spellingShingle |
bacteremia klebsiella pneumoniae carbapenemases enterobacterales bacteriemia klebsiella pneumoniae carbapenemasas enterobacterales Lipari, FG Morandini, FN Bettucci Ferrero, GN Ruiz, SE Irrazabal, G Cometto, A Hernandez, D Saka, HA Bacteremia caused by carbapenemase-producing and carbapenems-susceptible Klebsiella pneumoniae: clinical outcome, impact of COVID-19 and efficacy of ceftazidime/avibactam |
| topic_facet |
bacteremia klebsiella pneumoniae carbapenemases enterobacterales bacteriemia klebsiella pneumoniae carbapenemasas enterobacterales |
| author |
Lipari, FG Morandini, FN Bettucci Ferrero, GN Ruiz, SE Irrazabal, G Cometto, A Hernandez, D Saka, HA |
| author_facet |
Lipari, FG Morandini, FN Bettucci Ferrero, GN Ruiz, SE Irrazabal, G Cometto, A Hernandez, D Saka, HA |
| author_sort |
Lipari, FG |
| title |
Bacteremia caused by carbapenemase-producing and carbapenems-susceptible Klebsiella pneumoniae: clinical outcome, impact of COVID-19 and efficacy of ceftazidime/avibactam |
| title_short |
Bacteremia caused by carbapenemase-producing and carbapenems-susceptible Klebsiella pneumoniae: clinical outcome, impact of COVID-19 and efficacy of ceftazidime/avibactam |
| title_full |
Bacteremia caused by carbapenemase-producing and carbapenems-susceptible Klebsiella pneumoniae: clinical outcome, impact of COVID-19 and efficacy of ceftazidime/avibactam |
| title_fullStr |
Bacteremia caused by carbapenemase-producing and carbapenems-susceptible Klebsiella pneumoniae: clinical outcome, impact of COVID-19 and efficacy of ceftazidime/avibactam |
| title_full_unstemmed |
Bacteremia caused by carbapenemase-producing and carbapenems-susceptible Klebsiella pneumoniae: clinical outcome, impact of COVID-19 and efficacy of ceftazidime/avibactam |
| title_sort |
bacteremia caused by carbapenemase-producing and carbapenems-susceptible klebsiella pneumoniae: clinical outcome, impact of covid-19 and efficacy of ceftazidime/avibactam |
| description |
Bacteremia caused by carbapenemase-producing Klebsiella pneumoniae (CP-KPN-B) are a serious complication in hospitalized patients due to high morbidity and mortality rates and multi-resistance to antibiotics. There are very few studies comparing CP-KPN-B and those caused by carbapenems-susceptible K. pneumoniae (CS-KPN-B) in Argentina. The aim of this work was to compare the clinical and microbiological features of CP-KPN-B and CS-KPN-B.
An observational, retrospective, descriptive study was carried out to evaluate patients suffering K. pneumoniae bacteremia from 11/2019 to 03/2022 at the Hospital Privado Universitario de Cordoba. Demographic data, comorbidities and mortality were analyzed, among other variables. Bacterial typing was assessed by MALDI-TOF. Antimicrobial susceptibility testing was determined using VITEK-2. Carbapenemase types were identified by PCR (KPC, NDM, VIM, IMP, OXA-48/163). For statistical analysis of categorical data, comparison of proportions using Chi square was performed using MedCalc 14.8.1.
A total of 66 CP-KPN-B and 49 CS-KPN-B cases were studied. Carbapenemase types detected were KPC-70% (p<0.05), NDM-24%, KPC+NDM-5% and OXA-48/163-1%. A larger proportion of male patients (64%, p<0.05) was found in CP-KPN-B. Median age (CP-KPN-B/CS-KPN-B) was 58/64 years (p>0.05). Prior use of carbapenems was 41%/6%, appropriate empirical antibiotic treatment was 35%/75%, stay at critical care unit at the time of bacteremia was 50%/16% and median total length of hospitalization was 30/15 days (p<0.05). 30-day mortality in CP-KPN-B/CS-KPN-B was 39%/18% (OR 2.9; p=0,02). In CP-KPN-B patients treated with ceftazidime/avibactam (Caz/Avi, n=25) vs. other antibiotics (n=41), 30-day mortality was 20% and 51%, respectively (OR 4.2; p=0.02). No statistically significant differences in mortality of CP-KPN-B treated with Caz/Avi were observed in comparison with CS-KPN-B. In patients with CP-KPN-B and COVID-19 (n=13) vs. those with CP-KPN-B and other comorbidities, 30-day mortality was 77% and 30%, respectively (OR 4.2; p=0.01).
Clearly, patients suffering CP-KPN-B showed increased morbidity and worse prognosis. Association of CP-KPN-B and COVID-19 resulted in a marked increase in mortality. Caz/Avi was the best therapeutic option in CP-KPN-B, equaling mortality with CS-KPN-B. |
| publisher |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
| publishDate |
2022 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/39101 |
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I10-R327-article-391012024-04-15T16:14:45Z Bacteremia caused by carbapenemase-producing and carbapenems-susceptible Klebsiella pneumoniae: clinical outcome, impact of COVID-19 and efficacy of ceftazidime/avibactam Bacteriemias por Klebsiella pneumoniae productora de carbapenemasas y sensibles a carbapenems: evolución clínica, impacto de COVID-19 y eficacia de ceftazidima/avibactam Lipari, FG Morandini, FN Bettucci Ferrero, GN Ruiz, SE Irrazabal, G Cometto, A Hernandez, D Saka, HA bacteremia klebsiella pneumoniae carbapenemases enterobacterales bacteriemia klebsiella pneumoniae carbapenemasas enterobacterales Bacteremia caused by carbapenemase-producing Klebsiella pneumoniae (CP-KPN-B) are a serious complication in hospitalized patients due to high morbidity and mortality rates and multi-resistance to antibiotics. There are very few studies comparing CP-KPN-B and those caused by carbapenems-susceptible K. pneumoniae (CS-KPN-B) in Argentina. The aim of this work was to compare the clinical and microbiological features of CP-KPN-B and CS-KPN-B. An observational, retrospective, descriptive study was carried out to evaluate patients suffering K. pneumoniae bacteremia from 11/2019 to 03/2022 at the Hospital Privado Universitario de Cordoba. Demographic data, comorbidities and mortality were analyzed, among other variables. Bacterial typing was assessed by MALDI-TOF. Antimicrobial susceptibility testing was determined using VITEK-2. Carbapenemase types were identified by PCR (KPC, NDM, VIM, IMP, OXA-48/163). For statistical analysis of categorical data, comparison of proportions using Chi square was performed using MedCalc 14.8.1. A total of 66 CP-KPN-B and 49 CS-KPN-B cases were studied. Carbapenemase types detected were KPC-70% (p<0.05), NDM-24%, KPC+NDM-5% and OXA-48/163-1%. A larger proportion of male patients (64%, p<0.05) was found in CP-KPN-B. Median age (CP-KPN-B/CS-KPN-B) was 58/64 years (p>0.05). Prior use of carbapenems was 41%/6%, appropriate empirical antibiotic treatment was 35%/75%, stay at critical care unit at the time of bacteremia was 50%/16% and median total length of hospitalization was 30/15 days (p<0.05). 30-day mortality in CP-KPN-B/CS-KPN-B was 39%/18% (OR 2.9; p=0,02). In CP-KPN-B patients treated with ceftazidime/avibactam (Caz/Avi, n=25) vs. other antibiotics (n=41), 30-day mortality was 20% and 51%, respectively (OR 4.2; p=0.02). No statistically significant differences in mortality of CP-KPN-B treated with Caz/Avi were observed in comparison with CS-KPN-B. In patients with CP-KPN-B and COVID-19 (n=13) vs. those with CP-KPN-B and other comorbidities, 30-day mortality was 77% and 30%, respectively (OR 4.2; p=0.01). Clearly, patients suffering CP-KPN-B showed increased morbidity and worse prognosis. Association of CP-KPN-B and COVID-19 resulted in a marked increase in mortality. Caz/Avi was the best therapeutic option in CP-KPN-B, equaling mortality with CS-KPN-B. Las bacteriemias por Klebsiella pneumoniae productoras de carbapenemasas (B-KPNpc) son una grave complicación en pacientes hospitalizados por su elevada morbi-mortalidad y multirresistencia a los antibióticos. Existen muy pocos análisis comparativos entre estas y las bacteriemias por K. pneumoniae sensibles a carbapenems (B-KPNsc) en nuestro país. El objetivo de este trabajo fue comparar las características clínicas y microbiológicas de las B-KPNpc y B-KPNsc. Se realizó un estudio observacional, retrospectivo y descriptivo, analizando las bacteriemias de 11/2019 a 03/2022 del Hospital Privado Universitario de Córdoba. Se evaluaron características demográficas, comorbilidades y mortalidad entre otras variables. La tipificación bacteriana se realizó por MALDI-TOF. La sensibilidad se determinó por Vitek2. El tipo de carbapenemasa se confirmó mediante PCR (KPC, NDM, VIM, IMP, OXA-48/163). Para el análisis estadístico univariado de datos categóricos se utilizó la comparación de proporciones por Chi cuadrado (MedCalc 14.8.1). Se estudiaron 66 casos de B-KPNpc y 49 de B-KPNsc. Los tipos de carbapenemasa fueron: KPC (70%, p<0,05), NDM 24%, KPC+NDM 5% y OXA-48/163 1%. Se observó predominio de pacientes masculinos (64%) en B-KPNpc (p<0,05). La edad mediana (B-KPNpc/B-KPNsc) fue 58/64 años (p>0,05). El uso de carbapenems previo fue 41%/16%, el tratamiento empírico adecuado fue 35%/75%, la estadía en unidad de terapia intensiva al momento de la bacteriemia 50%/16% y la mediana del tiempo total de hospitalización fue 30/15 días (p<0,05). La mortalidad a los 30 días en B-KPNpc/B-KPNsc fue 39%/18% (OR 2,9; p=0,02). Se observó una mortalidad a los 30 días en B-KPNpc tratados con ceftazidima/avibactam (Caz/Avi, n=25) vs. otros antibióticos (n=41), de 20% y 51%, respectivamente (OR 4,2; p=0,02). No hubo diferencias significativas en la mortalidad de B-KPNpc tratados con Caz/Avi en comparación con B-KPNsc. En los pacientes con B-KPNpc y COVID-19 (n=13) vs. otras comorbilidades (n=53), la mortalidad a los 30 días fue 77% y 30 %, respectivamente (OR 4,2; p=0,01). Se observó con claridad en B-KPNpc una mayor morbilidad y peor pronóstico. La coinfeccion de B-KPNpc y COVID-19 resulto en marcado aumento de la mortalidad. Caz/Avi fue la mejor opción terapéutica en B-KPNpc igualando la mortalidad a las sensibles a carbapenems. Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2022-10-26 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion . https://revistas.unc.edu.ar/index.php/med/article/view/39101 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 79 No. Suplemento JIC XXIII (2022): Suplemento JIC XXIII Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 79 Núm. Suplemento JIC XXIII (2022): Suplemento JIC XXIII Revista da Faculdade de Ciências Médicas de Córdoba; v. 79 n. Suplemento JIC XXIII (2022): Suplemento JIC XXIII 1853-0605 0014-6722 http://creativecommons.org/licenses/by-nc/4.0 |