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Ceftazidime-Avibactam (C/A) Resistant, Meropenem Sensitive KPC-Producing Klebsiella pneumoniae in ICU Setting: We Are What We Are Treated with?

The continuous spread of carbapenem-resistant Klebsiella pneumoniae (CP-Kp) strains presents a severe challenge to the healthcare system due to limited therapeutic options and high mortality. Since its availability, ceftazidime/avibactam (C/A) has become a first-line option against KPC-Kp, but C/A-r...

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Autores principales: Corcione, Silvia, De Benedetto, Ilaria, Shbaklo, Nour, Torsello, Giulia, Lupia, Tommaso, Bianco, Gabriele, Cavallo, Rossana, Brazzi, Luca, Montrucchio, Giorgia, De Rosa, Francesco Giuseppe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10002972/
https://www.ncbi.nlm.nih.gov/pubmed/36902196
http://dx.doi.org/10.3390/ijms24054767
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author Corcione, Silvia
De Benedetto, Ilaria
Shbaklo, Nour
Torsello, Giulia
Lupia, Tommaso
Bianco, Gabriele
Cavallo, Rossana
Brazzi, Luca
Montrucchio, Giorgia
De Rosa, Francesco Giuseppe
author_facet Corcione, Silvia
De Benedetto, Ilaria
Shbaklo, Nour
Torsello, Giulia
Lupia, Tommaso
Bianco, Gabriele
Cavallo, Rossana
Brazzi, Luca
Montrucchio, Giorgia
De Rosa, Francesco Giuseppe
author_sort Corcione, Silvia
collection PubMed
description The continuous spread of carbapenem-resistant Klebsiella pneumoniae (CP-Kp) strains presents a severe challenge to the healthcare system due to limited therapeutic options and high mortality. Since its availability, ceftazidime/avibactam (C/A) has become a first-line option against KPC-Kp, but C/A-resistant strains have been reported increasingly, especially with pneumonia or prior suboptimal blood exposure to C/A treatment. A retrospective, observational study was conducted with all patients admitted to the Intensive Care Unit (ICU) dedicated to COVID-19 patients at the City of Health & Sciences in Turin, between 1 May 2021 and 31 January 2022, with the primary endpoint to study strains with resistance to C/A, and secondly to describe the characteristics of this population, with or without previous exposure to C/A. Seventeen patients with colonization or invasive infection due to Klebsiella pneumoniae, C/A resistance, and susceptibility to meropenem (MIC = 2 µg/L) were included; the bla(KPC) genotype was detected in all isolates revealing D179Y mutation in the bla(KPC-2) (bla(KPC-33)) gene. Cluster analysis showed that 16 out of the 17 C/A-resistant KPC-Kp isolates belonged to a single clone. Thirteen strains (76.5%) were isolated in a 60-day period. Only some patients had a previous infection with non-mutant KPC at other sites (5; 29.4%). Eight patients (47.1%) underwent previous large-spectrum antibiotic treatment, and four patients (23.5%) had prior treatment with C/A. The secondary spread of the D179Y mutation in the bla(KPC-2) during the COVID-19 pandemic needs to be addressed constantly by an interdisciplinary interaction between microbiologists, infection control personnel, clinicians, and infectious diseases consultants to properly diagnose and treat patients.
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spelling pubmed-100029722023-03-11 Ceftazidime-Avibactam (C/A) Resistant, Meropenem Sensitive KPC-Producing Klebsiella pneumoniae in ICU Setting: We Are What We Are Treated with? Corcione, Silvia De Benedetto, Ilaria Shbaklo, Nour Torsello, Giulia Lupia, Tommaso Bianco, Gabriele Cavallo, Rossana Brazzi, Luca Montrucchio, Giorgia De Rosa, Francesco Giuseppe Int J Mol Sci Article The continuous spread of carbapenem-resistant Klebsiella pneumoniae (CP-Kp) strains presents a severe challenge to the healthcare system due to limited therapeutic options and high mortality. Since its availability, ceftazidime/avibactam (C/A) has become a first-line option against KPC-Kp, but C/A-resistant strains have been reported increasingly, especially with pneumonia or prior suboptimal blood exposure to C/A treatment. A retrospective, observational study was conducted with all patients admitted to the Intensive Care Unit (ICU) dedicated to COVID-19 patients at the City of Health & Sciences in Turin, between 1 May 2021 and 31 January 2022, with the primary endpoint to study strains with resistance to C/A, and secondly to describe the characteristics of this population, with or without previous exposure to C/A. Seventeen patients with colonization or invasive infection due to Klebsiella pneumoniae, C/A resistance, and susceptibility to meropenem (MIC = 2 µg/L) were included; the bla(KPC) genotype was detected in all isolates revealing D179Y mutation in the bla(KPC-2) (bla(KPC-33)) gene. Cluster analysis showed that 16 out of the 17 C/A-resistant KPC-Kp isolates belonged to a single clone. Thirteen strains (76.5%) were isolated in a 60-day period. Only some patients had a previous infection with non-mutant KPC at other sites (5; 29.4%). Eight patients (47.1%) underwent previous large-spectrum antibiotic treatment, and four patients (23.5%) had prior treatment with C/A. The secondary spread of the D179Y mutation in the bla(KPC-2) during the COVID-19 pandemic needs to be addressed constantly by an interdisciplinary interaction between microbiologists, infection control personnel, clinicians, and infectious diseases consultants to properly diagnose and treat patients. MDPI 2023-03-01 /pmc/articles/PMC10002972/ /pubmed/36902196 http://dx.doi.org/10.3390/ijms24054767 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Corcione, Silvia
De Benedetto, Ilaria
Shbaklo, Nour
Torsello, Giulia
Lupia, Tommaso
Bianco, Gabriele
Cavallo, Rossana
Brazzi, Luca
Montrucchio, Giorgia
De Rosa, Francesco Giuseppe
Ceftazidime-Avibactam (C/A) Resistant, Meropenem Sensitive KPC-Producing Klebsiella pneumoniae in ICU Setting: We Are What We Are Treated with?
title Ceftazidime-Avibactam (C/A) Resistant, Meropenem Sensitive KPC-Producing Klebsiella pneumoniae in ICU Setting: We Are What We Are Treated with?
title_full Ceftazidime-Avibactam (C/A) Resistant, Meropenem Sensitive KPC-Producing Klebsiella pneumoniae in ICU Setting: We Are What We Are Treated with?
title_fullStr Ceftazidime-Avibactam (C/A) Resistant, Meropenem Sensitive KPC-Producing Klebsiella pneumoniae in ICU Setting: We Are What We Are Treated with?
title_full_unstemmed Ceftazidime-Avibactam (C/A) Resistant, Meropenem Sensitive KPC-Producing Klebsiella pneumoniae in ICU Setting: We Are What We Are Treated with?
title_short Ceftazidime-Avibactam (C/A) Resistant, Meropenem Sensitive KPC-Producing Klebsiella pneumoniae in ICU Setting: We Are What We Are Treated with?
title_sort ceftazidime-avibactam (c/a) resistant, meropenem sensitive kpc-producing klebsiella pneumoniae in icu setting: we are what we are treated with?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10002972/
https://www.ncbi.nlm.nih.gov/pubmed/36902196
http://dx.doi.org/10.3390/ijms24054767
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