• Pilato, Vincenzo Di
• Lombardi, Andrea
• Mazzitelli, Maria
• Bassetti, Matteo
• Cortegiani, Andrea
• Marelli, Cristina
• Oltolini, Chiara
• Losito, Angela Raffaella
• Vena, Antonio
• Bono, Valerio Del
• Trecarichi, Enrico Maria
• Rosa, Francesco Giuseppe De
• Giacobbe, Daniele Roberto
• Francisci, Daniela
• Puente, Filippo Del
• Fanelli, Chiara
• Momesso, Elena
• Giacomini, Mauro
• Meco, Gabriele Di
• Mikulska, Malgorzata
• Cattelan, Anna Maria
• Damico, Federico
• Graziani, Lucia
• Mularoni, Alessandra
• Merli, Marco
• Ciotta, Flavia Badalucco
• Aldieri, Chiara
• Marchese, Anna
• Russelli, Giovanna
• Gori, Andrea
• Calabresi, Alessandra
• Torti, Carlo
• Pontali, Emanuele
• Cattardico, Greta
• Spinicci, Michele
• Pallotto, Carlo
• Milazzo, Marta
• Serino, Francesco Saverio
• Signori, Alessio
• Raffaelli, Francesca
• Corcione, Silvi

Abstract

<jats:title>Abstract</jats:title><jats:sec><jats:title>Objectives</jats:title><jats:p>To assess the impact of carbapenem resistance on mortality in Klebsiella pneumoniae bloodstream infection (BSI) in the era of novel β-lactam/β-lactamase inhibitor combinations.</jats:p></jats:sec><jats:sec><jats:title>Material and methods</jats:title><jats:p>Retrospective study of patients with K. pneumoniae BSI between January and August 2020 in 16 centres (CARBANEW study within the MULTI-SITA project).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Overall, 426 patients were included: 107/426 (25%) had carbapenem-resistant K. pneumoniae (CR-Kp) BSI and 319/426 (75%) had carbapenem-susceptible K. pneumoniae (CS-Kp) BSI. Crude cumulative 30 day mortality was 33.8% and 20.7% in patients with, respectively, CR-Kp BSI and CS-Kp BSI (P = 0.027). Carbapenemase production or carbapenemase-encoding genes were detected in 84/98 tested CR-Kp isolates (85.7%), mainly KPC (78/84; 92.9%). Ceftazidime/avibactam was the most frequently used appropriate therapy for CR-Kp BSI (80/107; 74.7%). In multivariable analyses, variables showing an unfavourable association with mortality after correction for multiple testing were age-adjusted Charlson comorbidity index (HR 1.20; 95% CI 1.10–1.31, P &amp;lt; 0.001) and Pitt score (HR 1.33; 95% CI 1.15–1.55, P &amp;lt; 0.001), but not carbapenem resistance (HR 1.28, 95% CI 0.74–2.22, P = 0.410). In a propensity score-matched analysis, there was no difference in mortality between patients appropriately treated with ceftazidime/avibactam for CR-Kp BSI and patients appropriately treated with other agents (mainly meropenem monotherapy or piperacillin/tazobactam monotherapy) for CS-Kp BSI (HR 1.07; 95% CI 0.50–2.29, P = 0.866).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our results suggest that the increased mortality in CR-Kp BSI compared with CS-Kp BSI is not (or no longer) dependent on the type of therapy in areas where ceftazidime/avibactam-susceptible KPC-producing isolates are the most prevalent type of CR-Kp.</jats:p></jats:sec>

Topics

• impedance spectroscopy
• size-exclusion chromatography
• chemical ionisation