Cargando…

Risk Factors for Mortality in Patients with Klebsiella pneumoniae Carbapenemase-producing K. pneumoniae and Escherichia coli bacteremia

BACKGROUND: Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacterales bacteremia is associated with significant mortality; however, no optimal antibiotic strategy is available. We aimed to evaluate the clinical outcomes according to the antibiotic regimens and identify risk factors for mo...

Descripción completa

Detalles Bibliográficos
Autores principales: Seo, Hyeonji, Bae, Seongman, Kim, Min Jae, Chong, Yong Pil, Kim, Sung-Han, Lee, Sang-Oh, Choi, Sang-Ho, Kim, Yang Soo, Jung, Jiwon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Society of Infectious Diseases; Korean Society for Antimicrobial Therapy; The Korean Society for AIDS 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8511383/
https://www.ncbi.nlm.nih.gov/pubmed/34623781
http://dx.doi.org/10.3947/ic.2021.0083
_version_ 1784582749074489344
author Seo, Hyeonji
Bae, Seongman
Kim, Min Jae
Chong, Yong Pil
Kim, Sung-Han
Lee, Sang-Oh
Choi, Sang-Ho
Kim, Yang Soo
Jung, Jiwon
author_facet Seo, Hyeonji
Bae, Seongman
Kim, Min Jae
Chong, Yong Pil
Kim, Sung-Han
Lee, Sang-Oh
Choi, Sang-Ho
Kim, Yang Soo
Jung, Jiwon
author_sort Seo, Hyeonji
collection PubMed
description BACKGROUND: Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacterales bacteremia is associated with significant mortality; however, no optimal antibiotic strategy is available. We aimed to evaluate the clinical outcomes according to the antibiotic regimens and identify risk factors for mortality in patients with KPC-producing K. pneumoniae and Escherichia coli bacteremia. MATERIALS AND METHODS: This retrospective cohort study included all adult patients with monomicrobial bacteremia (KPC-producing K. pneumoniae or E. coli) between January 2011 and March 2021 at a 2,700-bed tertiary center. RESULTS: Ninety-two patients were identified; 7 with E. coli bacteremia, and 85 with K. pneumoniae bacteremia. Thirty-day mortality was 38.0% (35/92). Non-survivors were more likely to have had nosocomial infection (88.6% vs. 63.2%, P = 0.01), high APACHE II scores (mean [interquartile range], 22.0 [14.0 - 28.0] vs. 14.0 [11.0 - 20.5], P <0.001), and septic shock (51.4% vs. 26.3%, P <0.001) and less likely to have been admitted to the surgical ward (5.7% vs. 22.8%, P = 0.04), undergone removal of eradicable foci (61.5% vs. 90.6%, P = 0.03), and received appropriate combination treatment (57.1% vs. 78.9%, P = 0.03) than survivors. No significant difference in mortality was observed according to combination regimens including colistin, aminoglycoside, and tigecycline. In multivariable analysis, high APACHE II scores (adjusted odds ratio [aOR], 1.14; 95% confidence interval [CI], 1.06 - 1.23, P <0.001), and appropriate definitive treatment (aOR, 0.25; CI, 0.08 - 0.74, P = 0.01) were independent risk factors for mortality. CONCLUSION: High APACHE II scores and not receiving appropriate definitive treatment were associated with 30-day mortality. Mortality did not significantly differ according to combination regimens with conventional drugs such as aminoglycoside and colistin.
format Online
Article
Text
id pubmed-8511383
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher The Korean Society of Infectious Diseases; Korean Society for Antimicrobial Therapy; The Korean Society for AIDS
record_format MEDLINE/PubMed
spelling pubmed-85113832021-10-25 Risk Factors for Mortality in Patients with Klebsiella pneumoniae Carbapenemase-producing K. pneumoniae and Escherichia coli bacteremia Seo, Hyeonji Bae, Seongman Kim, Min Jae Chong, Yong Pil Kim, Sung-Han Lee, Sang-Oh Choi, Sang-Ho Kim, Yang Soo Jung, Jiwon Infect Chemother Original Article BACKGROUND: Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacterales bacteremia is associated with significant mortality; however, no optimal antibiotic strategy is available. We aimed to evaluate the clinical outcomes according to the antibiotic regimens and identify risk factors for mortality in patients with KPC-producing K. pneumoniae and Escherichia coli bacteremia. MATERIALS AND METHODS: This retrospective cohort study included all adult patients with monomicrobial bacteremia (KPC-producing K. pneumoniae or E. coli) between January 2011 and March 2021 at a 2,700-bed tertiary center. RESULTS: Ninety-two patients were identified; 7 with E. coli bacteremia, and 85 with K. pneumoniae bacteremia. Thirty-day mortality was 38.0% (35/92). Non-survivors were more likely to have had nosocomial infection (88.6% vs. 63.2%, P = 0.01), high APACHE II scores (mean [interquartile range], 22.0 [14.0 - 28.0] vs. 14.0 [11.0 - 20.5], P <0.001), and septic shock (51.4% vs. 26.3%, P <0.001) and less likely to have been admitted to the surgical ward (5.7% vs. 22.8%, P = 0.04), undergone removal of eradicable foci (61.5% vs. 90.6%, P = 0.03), and received appropriate combination treatment (57.1% vs. 78.9%, P = 0.03) than survivors. No significant difference in mortality was observed according to combination regimens including colistin, aminoglycoside, and tigecycline. In multivariable analysis, high APACHE II scores (adjusted odds ratio [aOR], 1.14; 95% confidence interval [CI], 1.06 - 1.23, P <0.001), and appropriate definitive treatment (aOR, 0.25; CI, 0.08 - 0.74, P = 0.01) were independent risk factors for mortality. CONCLUSION: High APACHE II scores and not receiving appropriate definitive treatment were associated with 30-day mortality. Mortality did not significantly differ according to combination regimens with conventional drugs such as aminoglycoside and colistin. The Korean Society of Infectious Diseases; Korean Society for Antimicrobial Therapy; The Korean Society for AIDS 2021-09 2021-09-15 /pmc/articles/PMC8511383/ /pubmed/34623781 http://dx.doi.org/10.3947/ic.2021.0083 Text en Copyright © 2021 by The Korean Society of Infectious Diseases, Korean Society for Antimicrobial Therapy, and The Korean Society for AIDS https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Seo, Hyeonji
Bae, Seongman
Kim, Min Jae
Chong, Yong Pil
Kim, Sung-Han
Lee, Sang-Oh
Choi, Sang-Ho
Kim, Yang Soo
Jung, Jiwon
Risk Factors for Mortality in Patients with Klebsiella pneumoniae Carbapenemase-producing K. pneumoniae and Escherichia coli bacteremia
title Risk Factors for Mortality in Patients with Klebsiella pneumoniae Carbapenemase-producing K. pneumoniae and Escherichia coli bacteremia
title_full Risk Factors for Mortality in Patients with Klebsiella pneumoniae Carbapenemase-producing K. pneumoniae and Escherichia coli bacteremia
title_fullStr Risk Factors for Mortality in Patients with Klebsiella pneumoniae Carbapenemase-producing K. pneumoniae and Escherichia coli bacteremia
title_full_unstemmed Risk Factors for Mortality in Patients with Klebsiella pneumoniae Carbapenemase-producing K. pneumoniae and Escherichia coli bacteremia
title_short Risk Factors for Mortality in Patients with Klebsiella pneumoniae Carbapenemase-producing K. pneumoniae and Escherichia coli bacteremia
title_sort risk factors for mortality in patients with klebsiella pneumoniae carbapenemase-producing k. pneumoniae and escherichia coli bacteremia
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8511383/
https://www.ncbi.nlm.nih.gov/pubmed/34623781
http://dx.doi.org/10.3947/ic.2021.0083
work_keys_str_mv AT seohyeonji riskfactorsformortalityinpatientswithklebsiellapneumoniaecarbapenemaseproducingkpneumoniaeandescherichiacolibacteremia
AT baeseongman riskfactorsformortalityinpatientswithklebsiellapneumoniaecarbapenemaseproducingkpneumoniaeandescherichiacolibacteremia
AT kimminjae riskfactorsformortalityinpatientswithklebsiellapneumoniaecarbapenemaseproducingkpneumoniaeandescherichiacolibacteremia
AT chongyongpil riskfactorsformortalityinpatientswithklebsiellapneumoniaecarbapenemaseproducingkpneumoniaeandescherichiacolibacteremia
AT kimsunghan riskfactorsformortalityinpatientswithklebsiellapneumoniaecarbapenemaseproducingkpneumoniaeandescherichiacolibacteremia
AT leesangoh riskfactorsformortalityinpatientswithklebsiellapneumoniaecarbapenemaseproducingkpneumoniaeandescherichiacolibacteremia
AT choisangho riskfactorsformortalityinpatientswithklebsiellapneumoniaecarbapenemaseproducingkpneumoniaeandescherichiacolibacteremia
AT kimyangsoo riskfactorsformortalityinpatientswithklebsiellapneumoniaecarbapenemaseproducingkpneumoniaeandescherichiacolibacteremia
AT jungjiwon riskfactorsformortalityinpatientswithklebsiellapneumoniaecarbapenemaseproducingkpneumoniaeandescherichiacolibacteremia