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Ten Years of KPC-Kp Bloodstream Infections Experience: Impact of Early Appropriate Empirical Therapy on Mortality

Background. In K. pneumoniae KPC (KPC-Kp) bloodstream infections (BSI), INCREMENT CPE score >7, Charlson Comorbidity Index (CCI) ≥3 and septic shock are recognized predictors of mortality, with a possible beneficial effect of combination therapy in seriously ill patients. Materials and Methods. W...

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Autores principales: Corcione, Silvia, De Benedetto, Ilaria, Shbaklo, Nour, Ranzani, Fabio, Mornese Pinna, Simone, Castiglione, Anna, Scabini, Silvia, Bianco, Gabriele, Cavallo, Rossana, Mirabella, Stefano, Romagnoli, Renato, De Rosa, Francesco Giuseppe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9776375/
https://www.ncbi.nlm.nih.gov/pubmed/36552024
http://dx.doi.org/10.3390/biomedicines10123268
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author Corcione, Silvia
De Benedetto, Ilaria
Shbaklo, Nour
Ranzani, Fabio
Mornese Pinna, Simone
Castiglione, Anna
Scabini, Silvia
Bianco, Gabriele
Cavallo, Rossana
Mirabella, Stefano
Romagnoli, Renato
De Rosa, Francesco Giuseppe
author_facet Corcione, Silvia
De Benedetto, Ilaria
Shbaklo, Nour
Ranzani, Fabio
Mornese Pinna, Simone
Castiglione, Anna
Scabini, Silvia
Bianco, Gabriele
Cavallo, Rossana
Mirabella, Stefano
Romagnoli, Renato
De Rosa, Francesco Giuseppe
author_sort Corcione, Silvia
collection PubMed
description Background. In K. pneumoniae KPC (KPC-Kp) bloodstream infections (BSI), INCREMENT CPE score >7, Charlson Comorbidity Index (CCI) ≥3 and septic shock are recognized predictors of mortality, with a possible beneficial effect of combination therapy in seriously ill patients. Materials and Methods. We conducted a ten-year retrospective study including all KPC-Kp BSI in patients ≥18 years of age with the aim to evaluate the characteristics and impact of appropriate empirical therapy, either monotherapy or combination therapy, and targeted therapy on mortality. Appropriate therapy was defined as at least one active antimicrobial agent with in vitro activity against KPC-kp demonstrated by susceptibility testing, administered within 48 h from blood culture collection. Results. The median age of the 435 analyzed patients was 66.09 years (IQR 54.87–73.98). The median CCI was 4. KPC-Kp colonization was present in 324 patients (74.48%). The probable origin of the KPC-Kp BSI was not identified in 136 patients (31.26%), whereas in 120 (27.59%) patients, it was CVC-related, and in 118 (27.13%), it was respiratory. Source control was achieved in 87 patients (72.5%) with CVC-related KPC-Kp BSI. The twenty-eight-day survival was 70.45% for empirical monotherapy, 63.88% for empirical combination therapy and 57.05% for targeted therapy (p = 0.0399). A probable source of KPC-Kp BSI other than urinary, CVC or abdominal [aHR 1.64 (IC 1.15–2.34) p = 0.006] and deferred targeted therapy [HR 1.67 (IC 1.12–2.51), p= 0.013] emerged as predictors of mortality, whereas source control [HR 0.62 (IC 0.44–0.86), p = 0.005] and ceftazidime/avibactam administration in empirical therapy [aHR 0.37 (IC 0.20–0.68) p = 0.002] appeared as protective factors. Discussion. These data underline the importance of source control together with timing appropriateness in the early start of empirical therapy over the choice of monotherapy or combination therapy and the use of ceftazidime/avibactam against KPC-Kp BSI.
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spelling pubmed-97763752022-12-23 Ten Years of KPC-Kp Bloodstream Infections Experience: Impact of Early Appropriate Empirical Therapy on Mortality Corcione, Silvia De Benedetto, Ilaria Shbaklo, Nour Ranzani, Fabio Mornese Pinna, Simone Castiglione, Anna Scabini, Silvia Bianco, Gabriele Cavallo, Rossana Mirabella, Stefano Romagnoli, Renato De Rosa, Francesco Giuseppe Biomedicines Article Background. In K. pneumoniae KPC (KPC-Kp) bloodstream infections (BSI), INCREMENT CPE score >7, Charlson Comorbidity Index (CCI) ≥3 and septic shock are recognized predictors of mortality, with a possible beneficial effect of combination therapy in seriously ill patients. Materials and Methods. We conducted a ten-year retrospective study including all KPC-Kp BSI in patients ≥18 years of age with the aim to evaluate the characteristics and impact of appropriate empirical therapy, either monotherapy or combination therapy, and targeted therapy on mortality. Appropriate therapy was defined as at least one active antimicrobial agent with in vitro activity against KPC-kp demonstrated by susceptibility testing, administered within 48 h from blood culture collection. Results. The median age of the 435 analyzed patients was 66.09 years (IQR 54.87–73.98). The median CCI was 4. KPC-Kp colonization was present in 324 patients (74.48%). The probable origin of the KPC-Kp BSI was not identified in 136 patients (31.26%), whereas in 120 (27.59%) patients, it was CVC-related, and in 118 (27.13%), it was respiratory. Source control was achieved in 87 patients (72.5%) with CVC-related KPC-Kp BSI. The twenty-eight-day survival was 70.45% for empirical monotherapy, 63.88% for empirical combination therapy and 57.05% for targeted therapy (p = 0.0399). A probable source of KPC-Kp BSI other than urinary, CVC or abdominal [aHR 1.64 (IC 1.15–2.34) p = 0.006] and deferred targeted therapy [HR 1.67 (IC 1.12–2.51), p= 0.013] emerged as predictors of mortality, whereas source control [HR 0.62 (IC 0.44–0.86), p = 0.005] and ceftazidime/avibactam administration in empirical therapy [aHR 0.37 (IC 0.20–0.68) p = 0.002] appeared as protective factors. Discussion. These data underline the importance of source control together with timing appropriateness in the early start of empirical therapy over the choice of monotherapy or combination therapy and the use of ceftazidime/avibactam against KPC-Kp BSI. MDPI 2022-12-16 /pmc/articles/PMC9776375/ /pubmed/36552024 http://dx.doi.org/10.3390/biomedicines10123268 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
Corcione, Silvia
De Benedetto, Ilaria
Shbaklo, Nour
Ranzani, Fabio
Mornese Pinna, Simone
Castiglione, Anna
Scabini, Silvia
Bianco, Gabriele
Cavallo, Rossana
Mirabella, Stefano
Romagnoli, Renato
De Rosa, Francesco Giuseppe
Ten Years of KPC-Kp Bloodstream Infections Experience: Impact of Early Appropriate Empirical Therapy on Mortality
title Ten Years of KPC-Kp Bloodstream Infections Experience: Impact of Early Appropriate Empirical Therapy on Mortality
title_full Ten Years of KPC-Kp Bloodstream Infections Experience: Impact of Early Appropriate Empirical Therapy on Mortality
title_fullStr Ten Years of KPC-Kp Bloodstream Infections Experience: Impact of Early Appropriate Empirical Therapy on Mortality
title_full_unstemmed Ten Years of KPC-Kp Bloodstream Infections Experience: Impact of Early Appropriate Empirical Therapy on Mortality
title_short Ten Years of KPC-Kp Bloodstream Infections Experience: Impact of Early Appropriate Empirical Therapy on Mortality
title_sort ten years of kpc-kp bloodstream infections experience: impact of early appropriate empirical therapy on mortality
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9776375/
https://www.ncbi.nlm.nih.gov/pubmed/36552024
http://dx.doi.org/10.3390/biomedicines10123268
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