Cargando…

Prompt and Appropriate Antimicrobial Therapy Improves Outcomes of NDM-Producing and KPC-Producing Klebsiella pneumoniae Bloodstream Infections in Patients Hospitalized for COVID-19: A Comparative Retrospective Case-Series

Secondary bloodstream infections (BSIs) caused by KPC- and NDM-producing Klebsiella pneumoniae (K.p.) during the course of COVID-19 infections lead to significant mortality. Herein, a comparative retrospective case series of KPC- or NDM-K.p. BSIs occurring in COVID-19 subjects treated with Ceftazidi...

Descripción completa

Detalles Bibliográficos
Autores principales: Bavaro, Davide Fiore, Belati, Alessandra, Diella, Lucia, Poli, Melita Anna, Calamo, Angela, De Candia, Giovanna, Altamura, Maurantonio, Spadavecchia, Felicia Anna, Brindicci, Gaetano, De Gennaro, Nicolò, Di Gennaro, Francesco, Saracino, Annalisa, Carbonara, Sergio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9686740/
https://www.ncbi.nlm.nih.gov/pubmed/36358174
http://dx.doi.org/10.3390/antibiotics11111519
_version_ 1784835828310081536
author Bavaro, Davide Fiore
Belati, Alessandra
Diella, Lucia
Poli, Melita Anna
Calamo, Angela
De Candia, Giovanna
Altamura, Maurantonio
Spadavecchia, Felicia Anna
Brindicci, Gaetano
De Gennaro, Nicolò
Di Gennaro, Francesco
Saracino, Annalisa
Carbonara, Sergio
author_facet Bavaro, Davide Fiore
Belati, Alessandra
Diella, Lucia
Poli, Melita Anna
Calamo, Angela
De Candia, Giovanna
Altamura, Maurantonio
Spadavecchia, Felicia Anna
Brindicci, Gaetano
De Gennaro, Nicolò
Di Gennaro, Francesco
Saracino, Annalisa
Carbonara, Sergio
author_sort Bavaro, Davide Fiore
collection PubMed
description Secondary bloodstream infections (BSIs) caused by KPC- and NDM-producing Klebsiella pneumoniae (K.p.) during the course of COVID-19 infections lead to significant mortality. Herein, a comparative retrospective case series of KPC- or NDM-K.p. BSIs occurring in COVID-19 subjects treated with Ceftazidime/Avibactam (CAZ/AVI) for KPC-K.p., or CAZ/AVI+ Aztreonam (ATM) for NDM-K.p is reported. All patients hospitalized for COVID-19 in two Italian hospitals with a BSI between March and September 2021 were included. The main outcome was 14-day mortality. Overall, 44 patients were included: 23 with KPC-K.p. and 21 with NDM-K.p. BSIs. The median (q1–q3) age was 67 (57–75) years, and 32 (72%) were males. The two groups were similar in terms of baseline comorbidity, or severity of COVID-19. Notably, 14-day mortality of KPC-K.p. BSIs and NDM-K.p. BSIs (26% vs. 38%, p = 0.521) and 28-day mortality (35% vs. 48%, p = 0.541) were similar. A Cox regression model of delayed initiation of an appropriate antibiotic therapy after the onset of symptoms independently predicted mortality: initiation between 24 and 72 h (aHR = 12.03; 95% CI = 1.10–130, p = 0.041); and initiation after 72h (aHR = 36.9, 95% CI = 3.22–424, p = 0.004). Moreover, a trend towards an increased risk of mortality was observed for polymicrobial infections (aHR = 3.73, 95% CI = 0.87–15.8, p = 0.074), while a protective effect was observed for a beta-lactam loading dose at the start of treatment (aHR = 0.16, 95% CI = 0.02–1.10, p = 0.064). The high mortality of KPC and NDM-K.p. BSIs in COVID-19 patients may be reduced by an early and appropriate antibiotic therapy. Further efforts should be made to develop antimicrobial stewardship and infection control programs in COVID-19 wards.
format Online
Article
Text
id pubmed-9686740
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-96867402022-11-25 Prompt and Appropriate Antimicrobial Therapy Improves Outcomes of NDM-Producing and KPC-Producing Klebsiella pneumoniae Bloodstream Infections in Patients Hospitalized for COVID-19: A Comparative Retrospective Case-Series Bavaro, Davide Fiore Belati, Alessandra Diella, Lucia Poli, Melita Anna Calamo, Angela De Candia, Giovanna Altamura, Maurantonio Spadavecchia, Felicia Anna Brindicci, Gaetano De Gennaro, Nicolò Di Gennaro, Francesco Saracino, Annalisa Carbonara, Sergio Antibiotics (Basel) Article Secondary bloodstream infections (BSIs) caused by KPC- and NDM-producing Klebsiella pneumoniae (K.p.) during the course of COVID-19 infections lead to significant mortality. Herein, a comparative retrospective case series of KPC- or NDM-K.p. BSIs occurring in COVID-19 subjects treated with Ceftazidime/Avibactam (CAZ/AVI) for KPC-K.p., or CAZ/AVI+ Aztreonam (ATM) for NDM-K.p is reported. All patients hospitalized for COVID-19 in two Italian hospitals with a BSI between March and September 2021 were included. The main outcome was 14-day mortality. Overall, 44 patients were included: 23 with KPC-K.p. and 21 with NDM-K.p. BSIs. The median (q1–q3) age was 67 (57–75) years, and 32 (72%) were males. The two groups were similar in terms of baseline comorbidity, or severity of COVID-19. Notably, 14-day mortality of KPC-K.p. BSIs and NDM-K.p. BSIs (26% vs. 38%, p = 0.521) and 28-day mortality (35% vs. 48%, p = 0.541) were similar. A Cox regression model of delayed initiation of an appropriate antibiotic therapy after the onset of symptoms independently predicted mortality: initiation between 24 and 72 h (aHR = 12.03; 95% CI = 1.10–130, p = 0.041); and initiation after 72h (aHR = 36.9, 95% CI = 3.22–424, p = 0.004). Moreover, a trend towards an increased risk of mortality was observed for polymicrobial infections (aHR = 3.73, 95% CI = 0.87–15.8, p = 0.074), while a protective effect was observed for a beta-lactam loading dose at the start of treatment (aHR = 0.16, 95% CI = 0.02–1.10, p = 0.064). The high mortality of KPC and NDM-K.p. BSIs in COVID-19 patients may be reduced by an early and appropriate antibiotic therapy. Further efforts should be made to develop antimicrobial stewardship and infection control programs in COVID-19 wards. MDPI 2022-10-31 /pmc/articles/PMC9686740/ /pubmed/36358174 http://dx.doi.org/10.3390/antibiotics11111519 Text en © 2022 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
Bavaro, Davide Fiore
Belati, Alessandra
Diella, Lucia
Poli, Melita Anna
Calamo, Angela
De Candia, Giovanna
Altamura, Maurantonio
Spadavecchia, Felicia Anna
Brindicci, Gaetano
De Gennaro, Nicolò
Di Gennaro, Francesco
Saracino, Annalisa
Carbonara, Sergio
Prompt and Appropriate Antimicrobial Therapy Improves Outcomes of NDM-Producing and KPC-Producing Klebsiella pneumoniae Bloodstream Infections in Patients Hospitalized for COVID-19: A Comparative Retrospective Case-Series
title Prompt and Appropriate Antimicrobial Therapy Improves Outcomes of NDM-Producing and KPC-Producing Klebsiella pneumoniae Bloodstream Infections in Patients Hospitalized for COVID-19: A Comparative Retrospective Case-Series
title_full Prompt and Appropriate Antimicrobial Therapy Improves Outcomes of NDM-Producing and KPC-Producing Klebsiella pneumoniae Bloodstream Infections in Patients Hospitalized for COVID-19: A Comparative Retrospective Case-Series
title_fullStr Prompt and Appropriate Antimicrobial Therapy Improves Outcomes of NDM-Producing and KPC-Producing Klebsiella pneumoniae Bloodstream Infections in Patients Hospitalized for COVID-19: A Comparative Retrospective Case-Series
title_full_unstemmed Prompt and Appropriate Antimicrobial Therapy Improves Outcomes of NDM-Producing and KPC-Producing Klebsiella pneumoniae Bloodstream Infections in Patients Hospitalized for COVID-19: A Comparative Retrospective Case-Series
title_short Prompt and Appropriate Antimicrobial Therapy Improves Outcomes of NDM-Producing and KPC-Producing Klebsiella pneumoniae Bloodstream Infections in Patients Hospitalized for COVID-19: A Comparative Retrospective Case-Series
title_sort prompt and appropriate antimicrobial therapy improves outcomes of ndm-producing and kpc-producing klebsiella pneumoniae bloodstream infections in patients hospitalized for covid-19: a comparative retrospective case-series
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9686740/
https://www.ncbi.nlm.nih.gov/pubmed/36358174
http://dx.doi.org/10.3390/antibiotics11111519
work_keys_str_mv AT bavarodavidefiore promptandappropriateantimicrobialtherapyimprovesoutcomesofndmproducingandkpcproducingklebsiellapneumoniaebloodstreaminfectionsinpatientshospitalizedforcovid19acomparativeretrospectivecaseseries
AT belatialessandra promptandappropriateantimicrobialtherapyimprovesoutcomesofndmproducingandkpcproducingklebsiellapneumoniaebloodstreaminfectionsinpatientshospitalizedforcovid19acomparativeretrospectivecaseseries
AT diellalucia promptandappropriateantimicrobialtherapyimprovesoutcomesofndmproducingandkpcproducingklebsiellapneumoniaebloodstreaminfectionsinpatientshospitalizedforcovid19acomparativeretrospectivecaseseries
AT polimelitaanna promptandappropriateantimicrobialtherapyimprovesoutcomesofndmproducingandkpcproducingklebsiellapneumoniaebloodstreaminfectionsinpatientshospitalizedforcovid19acomparativeretrospectivecaseseries
AT calamoangela promptandappropriateantimicrobialtherapyimprovesoutcomesofndmproducingandkpcproducingklebsiellapneumoniaebloodstreaminfectionsinpatientshospitalizedforcovid19acomparativeretrospectivecaseseries
AT decandiagiovanna promptandappropriateantimicrobialtherapyimprovesoutcomesofndmproducingandkpcproducingklebsiellapneumoniaebloodstreaminfectionsinpatientshospitalizedforcovid19acomparativeretrospectivecaseseries
AT altamuramaurantonio promptandappropriateantimicrobialtherapyimprovesoutcomesofndmproducingandkpcproducingklebsiellapneumoniaebloodstreaminfectionsinpatientshospitalizedforcovid19acomparativeretrospectivecaseseries
AT spadavecchiafeliciaanna promptandappropriateantimicrobialtherapyimprovesoutcomesofndmproducingandkpcproducingklebsiellapneumoniaebloodstreaminfectionsinpatientshospitalizedforcovid19acomparativeretrospectivecaseseries
AT brindiccigaetano promptandappropriateantimicrobialtherapyimprovesoutcomesofndmproducingandkpcproducingklebsiellapneumoniaebloodstreaminfectionsinpatientshospitalizedforcovid19acomparativeretrospectivecaseseries
AT degennaronicolo promptandappropriateantimicrobialtherapyimprovesoutcomesofndmproducingandkpcproducingklebsiellapneumoniaebloodstreaminfectionsinpatientshospitalizedforcovid19acomparativeretrospectivecaseseries
AT digennarofrancesco promptandappropriateantimicrobialtherapyimprovesoutcomesofndmproducingandkpcproducingklebsiellapneumoniaebloodstreaminfectionsinpatientshospitalizedforcovid19acomparativeretrospectivecaseseries
AT saracinoannalisa promptandappropriateantimicrobialtherapyimprovesoutcomesofndmproducingandkpcproducingklebsiellapneumoniaebloodstreaminfectionsinpatientshospitalizedforcovid19acomparativeretrospectivecaseseries
AT carbonarasergio promptandappropriateantimicrobialtherapyimprovesoutcomesofndmproducingandkpcproducingklebsiellapneumoniaebloodstreaminfectionsinpatientshospitalizedforcovid19acomparativeretrospectivecaseseries