Mortality of Pandrug-Resistant Klebsiella pneumoniae Bloodstream Infections in Critically Ill Patients: A Retrospective Cohort of 115 Episodes
Abstract
:1. Introduction
2. Results
3. Discussion
4. Materials and Methods
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | All Patients | Patients with Septic Shock | ||||
---|---|---|---|---|---|---|
Survivors (n = 70) | Non-Survivors (n = 45) | p | Survivors (n = 23) | Non-Survivors (n = 28) | p | |
Demographics | ||||||
Age (years) | 51.5 ± 18.6 | 62.1 ± 15.4 | 0.003 | 59.3 ± 18.5 | 59.4 ± 15.9 | 0.947 |
Male gender | 49 (70.0%) | 26 (57.8%) | 0.229 | 17 (73.9%) | 18 (64.3%) | 0.552 |
Comorbidities | ||||||
Diabetes mellitus | 9 (12.9%) | 10 (22.2%) | 0.207 | 2 (8.7%) | 6 (21.4%) | 0.269 |
Chronic obstructive pulmonary disease | 3 (4.3%) | 7 (15.6%) | 0.047 | 0 (0.0%) | 4 (14.3%) | 0.117 |
Chronic heart failure | 3 (4.3%) | 8 (17.8%) | 0.023 | 0 (0.0%) | 4 (14.3%) | 0.117 |
Chronic kidney disease | 1 (1.2%) | 1 (2.2%) | 1.000 | 1 (4.3%) | 0 (0.0%) | 0.451 |
Malignancy | 6 (8.6%) | 9 (20.0%) | 0.093 | 2 (8.7%) | 4 (14.3%) | 0.678 |
Immunosuppressive therapy | 3 (4.3%) | 5 (11.1%) | 0.259 | 1 (4.3%) | 2 (7.1%) | 1.000 |
Obesity | 20 (28.6%) | 16 (35.6%) | 0.537 | 5 (21.7%) | 11 (39.3%) | 0.232 |
Charlson comorbidity index | 2.5 ± 3.2 | 4.8 ± 4.3 | 0.002 | 2.8 ± 3.0 | 4.1 ± 3.8 | 0.292 |
Infection data | ||||||
Prior surgery (within a month form infection onset) | 34 (48.6%) | 23 (51.1%) | 0.850 | 10 (43.5%) | 16 (57.1%) | 0.404 |
Days at risk (from ICU admission to infection onset) | 27.4 ± 26.5 | 21.5 ± 21.4 | 0.168 | 30.6 ± 35.2 | 21.6 ± 22.2 | 0.464 |
Isolate carrying blaKPC | 59 (84.3%) | 39 (86.7%) | 0.794 | 18 (78.3%) | 25 (89.3%) | 0.442 |
Septic shock | 23 (32.9%) | 28 (62.2%) | 0.002 | - | - | - |
Type of infection | ||||||
Primary BSI | 34 (48.6%) | 19 (42.2%) | 12 (52.2%) | 10 (35.7%) | ||
Catheter-related BSI | 28 (40.0%) | 7 (15.6%) | 8 (34.8%) | 4 (14.3%) | ||
Othera | 8 (11.4%) | 19 (42.2%) | <0.001b | 3 (13.0%) | 14 (50.0%) | 0.007b |
Antimicrobial treatment | ||||||
Monotherapy | 1 (1.4%) | 7 (15.6%) | 0 (0.0%) | 2 (7.1%) | ||
Combination of two antimicrobials | 9 (12.9%) | 13 (28.9%) | 1 (4.3%) | 7 (25.0%) | ||
Combination of three or more antimicrobials | 60 (85.7%) | 25 (55.6%) | <0.001 | 22 (95.7%) | 19 (67.9%) | 0.015 |
Carbapenem-including treatment | 66 (94.3%) | 40 (88.9%) | 0.310 | 21 (91.3%) | 26 (92.9%) | 1.000 |
Colistin-including treatment | 64 (91.4%) | 38 (84.4%) | 0.366 | 22 (95.7%) | 25 (89.3%) | 0.617 |
Aminoglycoside-including treatment | 47 (67.1%) | 20 (44.4%) | 0.020 | 16 (69.6%) | 14 (50.0%) | 0.253 |
Tigecycline-including treatment | 48 (68.6%) | 24 (53.3%) | 0.117 | 18 (78.3%) | 20 (71.4%) | 0.749 |
Corticosteroid administration during infection | 37 (52.9%) | 32 (71.1%) | 0.055 | 13 (56.5%) | 21 (75.0%) | 0.234 |
Characteristics | All Patients | Patients with Septic Shock | ||
---|---|---|---|---|
p | OR (95% CI) | p | OR (95% CI) | |
Septic shock | 0.002 | 5.2 (1.8–15.0) | ||
Charlson comorbidity index | 0.012 | 1.2 (1.0–1.3) | ||
BSI other than primary or catheter-related | 0.001 | 6.4 (2.0–20.2) | 0.008 | 7.4 (1.7–33.0) |
Combination of at least three antimicrobials | <0.001 | 0.105 (0.032–0.344) | 0.029 | 0.083 (0.009–0.774) |
Treatment Regimen | Survivors (n = 70) | Non-Survivors (n = 45) | Mortality (%) |
---|---|---|---|
One antimicrobial | 1 | 7 | 87.5 |
Carbapenem | 1 | 4 | 80.0 |
Colistin | 0 | 2 | 100 |
Gentamicin | 0 | 1 | 100 |
Two antimicrobials | 9 | 13 | 59.1 |
Carbapenem + Aminoglycoside | 2 | 1 | 33.3 |
Colistin + Tigecycline | 0 | 1 | 100 |
Carbapenem + Tigecycline | 2 | 1 | 33.3 |
Carbapenem + Colistin | 5 | 10 | 66.7 |
Three antimicrobials | 30 | 9 | 23.1 |
Colistin + Tigecycline + Aminoglycoside | 2 | 0 | 0.0 |
Carbapenem + Tigecycline + Aminoglycoside | 15 | 3 | 16.7 |
Colistin + Tigecycline + Carbapenem | 10 | 5 | 33.3 |
Colistin + Carbapenem + Aminoglycoside | 1 | 0 | 0.0 |
Colistin + Tigecycline + Ceftazidime/avibactam | 1 | 0 | 0.0 |
Colistin + Tigecycline + Fosfomycin | 1 | 1 | 50.0 |
Four or more antimicrobials | 30 | 16 | 34.8 |
Carbapenem + Colistin + Tigecycline + Aminoglycoside | 25 | 15 | 37.5 |
Carbapenem + Colistin + Tigecycline + Aminoglycoside + other antimicrobial | 3 | 0 | 0.0 |
Double carbapenem + Colistin + Tigecycline + Aminoglycoside | 2 | 0 | 0.0 |
Carbapenem + Colistin + Tigecycline + Fosfomycin | 0 | 1 | 100 |
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Papadimitriou-Olivgeris, M.; Bartzavali, C.; Georgakopoulou, A.; Kolonitsiou, F.; Papamichail, C.; Spiliopoulou, I.; Christofidou, M.; Fligou, F.; Marangos, M. Mortality of Pandrug-Resistant Klebsiella pneumoniae Bloodstream Infections in Critically Ill Patients: A Retrospective Cohort of 115 Episodes. Antibiotics 2021, 10, 76. https://doi.org/10.3390/antibiotics10010076
Papadimitriou-Olivgeris M, Bartzavali C, Georgakopoulou A, Kolonitsiou F, Papamichail C, Spiliopoulou I, Christofidou M, Fligou F, Marangos M. Mortality of Pandrug-Resistant Klebsiella pneumoniae Bloodstream Infections in Critically Ill Patients: A Retrospective Cohort of 115 Episodes. Antibiotics. 2021; 10(1):76. https://doi.org/10.3390/antibiotics10010076
Chicago/Turabian StylePapadimitriou-Olivgeris, Matthaios, Christina Bartzavali, Alexandra Georgakopoulou, Fevronia Kolonitsiou, Chrisavgi Papamichail, Iris Spiliopoulou, Myrto Christofidou, Fotini Fligou, and Markos Marangos. 2021. "Mortality of Pandrug-Resistant Klebsiella pneumoniae Bloodstream Infections in Critically Ill Patients: A Retrospective Cohort of 115 Episodes" Antibiotics 10, no. 1: 76. https://doi.org/10.3390/antibiotics10010076