Rapid diagnostics and ceftazidime/avibactam for KPC-producing Klebsiella pneumoniae bloodstream infections: impact on mortality and role of combination therapy.
In: European Journal of Clinical Microbiology & Infectious Diseases, Jg. 42 (2023-04-01), Heft 4, S. 431-439
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Zugriff:
This study was aimed at investigating risk factors for mortality in patients suffering from KPC-producing Klebsiella pneumoniae (KPC-Kp) bloodstream infections (BSIs), evaluating the impact of rapid diagnostics and ceftazidime/avibactam use. This observational retrospective study (January 2017–May 2021) included all patients with a KPC-Kp BSI. Uni-multivariable analyses were carried out to evaluate the effect of clinical variables on both in-hospital death (IHD) and 30-day all-cause mortality, and the role of the combination of ceftazidime/avibactam plus polymyxin. One hundred and ninety-six patients met the study's inclusion criteria. Older age, having undergone renal replacement therapy during the 30 days preceding the KPC-Kp BSI onset, having an INCREMENT-CPE score ≥ 8, and having suffered from a superimposed and/or following KPC-Kp BSI treatment candidemia were found to be the main factors associated with both mortality rates. Among protective factors, the centrality of ceftazidime/avibactam in monotherapy (IHD: OR: 0.34; CI 95%: 0.11–1.00—30-day all-cause mortality: OR: 0.18; CI 95%: 0.04–0.77) or combination (IHD: OR: 0.51; CI 95%: 0.22–1.19—30-day all-cause mortality: OR: 0.62; CI 95%: 0.21–1.84) emerged and became even more evident once the effect of ceftazidime/avibactam plus polymyxin was removed. Rapid diagnostics may be useful to adopt more effective strategies for the treatment of KPC-Kp BSI patients and implement infection control measures, even if not associated with higher patient survival. Ceftazidime/avibactam, even when used alone, represents an important option against KPC-Kp, while combined use with polymyxin might not have altered its efficacy. Patient comorbidities, severity of BSI, and complications such as candidemia were confirmed to have a significant burden on survival. [ABSTRACT FROM AUTHOR]
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Rapid diagnostics and ceftazidime/avibactam for KPC-producing Klebsiella pneumoniae bloodstream infections: impact on mortality and role of combination therapy.
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Autor/in / Beteiligte Person: | Boattini, Matteo ; Bianco, Gabriele ; Charrier, Lorena ; Comini, Sara ; Iannaccone, Marco ; Almeida, André ; Cavallo, Rossana ; De Rosa, Francesco Giuseppe ; Costa, Cristina |
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Zeitschrift: | European Journal of Clinical Microbiology & Infectious Diseases, Jg. 42 (2023-04-01), Heft 4, S. 431-439 |
Veröffentlichung: | 2023 |
Medientyp: | academicJournal |
ISSN: | 0934-9723 (print) |
DOI: | 10.1007/s10096-023-04577-x |
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