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Review
. 2014 Oct;93(17):298-309.
doi: 10.1097/MD.0000000000000111.

Klebsiella pneumoniae bloodstream infection: epidemiology and impact of inappropriate empirical therapy

Nicolò Girometti  1 , Russell E Lewis, Maddalena Giannella, Simone Ambretti, Michele Bartoletti, Sara Tedeschi, Fabio Tumietto, Francesco Cristini, Filippo Trapani, Paolo Gaibani, Pierluigi Viale
Affiliations
Review

Klebsiella pneumoniae bloodstream infection: epidemiology and impact of inappropriate empirical therapy

Nicolò Girometti et al. Medicine (Baltimore). 2014 Oct.

Abstract

Multidrug resistance associated with extended-spectrum beta-lactamase (ESBL) and Klebsiella pneumoniae carbapenemase (KPC) among K. pneumoniae is endemic in southern Europe. We retrospectively analyzed the impact of resistance on the appropriateness of empirical therapy and treatment outcomes of K. pneumoniae bloodstream infections (BSIs) during a 2-year period at a 1420-bed tertiary-care teaching hospital in northern Italy. We identified 217 unique patient BSIs, including 92 (42%) KPC-positive, 49 (23%) ESBL-positive, and 1 (0.5%) metallo-beta-lactamase-positive isolates. Adequate empirical therapy was administered in 74% of infections caused by non-ESBL non-KPC strains, versus 33% of ESBL and 23% of KPC cases (p < 0.0001). To clarify the impact of resistance on BSI treatment outcomes, we compared several different models comprised of non-antibiotic treatment-related factors predictive of patients' 30-day survival status. Acute Physiology and Chronic Health Evaluation (APACHE) II score determined at the time of positive blood culture was superior to other investigated models, correctly predicting survival status in 83% of the study cohort. In multivariate analysis accounting for APACHE II, receipt of inadequate empirical therapy was associated with nearly a twofold higher rate of death (adjusted hazard ratio 1.9, 95% confidence interval 1.1-3.4; p = 0.02). Multidrug-resistant K. pneumoniae accounted for two-thirds of all K. pneumoniae BSIs, high rates of inappropriate empirical therapy, and twofold higher rates of patient death irrespective of underlying illness.

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Conflict of interest statement

Financial support and conflicts of interest: The authors have no funding or conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Probability of adequate empirical appropriate antibiotic therapy for K. pneumoniae bloodstream infection by (a) resistance mechanism and (b) impact on survival. P values were determined by (a) chi-square or (b) differences in survival probability was estimated using Cox-proportional hazard regression adjusted for patient APACHE II score calculated at the time of positive blood culture.
See this image and copyright information in PMC

References

    1. Akova M, Daikos GL, Tzouvelekis L, et al. Interventional strategies and current clinical experience with carbapenemase-producing Gram-negative bacteria. Clin Microbiol Infect. 2012;18:439–448. - PubMed
    1. Anderson DJ, Engemann JJ, Harrell LJ, et al. Predictors of mortality in patients with bloodstream infection due to ceftazidime-resistant Klebsiella pneumoniae. Antimicrob Agents Chemother. 2006;50:1715–1720. - PMC - PubMed
    1. Anderson DJ, Richet H, Chen LF, et al. Seasonal variation in Klebsiella pneumoniae bloodstream infection on 4 continents. J Infect Dis. 2008;197:752–756. - PubMed
    1. Anderson KF, Lonsway DR, Rasheed JK, et al. Evaluation of methods to identify the Klebsiella pneumoniae carbapenemase in Enterobacteriaceae. J Clin Microbiol. 2007;45:2723–2725. - PMC - PubMed
    1. Anonymous. Performance standards for antimicrobial susceptibility testing. National Committee for Clinical Laboratory Standards 12th Informational Supplement M100-S12. Wayne, PA: National Committee for Clinical Laboratory Standards; 2002.

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