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. 2023 Oct 3;78(10):2505-2514.
doi: 10.1093/jac/dkad262.

Mortality in KPC-producing Klebsiella pneumoniae bloodstream infections: a changing landscape

Daniele Roberto Giacobbe  1   2 , Cristina Marelli  2 , Greta Cattardico  1   2 , Chiara Fanelli  2   3 , Alessio Signori  4 , Gabriele Di Meco  2 , Vincenzo Di Pilato  5 , Malgorzata Mikulska  1   2 , Maria Mazzitelli  6 , Anna Maria Cattelan  6   7 , Carlo Pallotto  8 , Daniela Francisci  8 , Alessandra Calabresi  9 , Andrea Lombardi  10   11 , Andrea Gori  11   12 , Valerio Del Bono  13 , Chiara Aldieri  13 , Angela Raffaella Losito  14 , Francesca Raffaelli  14 , Andrea Cortegiani  15   16 , Marta Milazzo  15 , Filippo Del Puente  17 , Emanuele Pontali  17 , Francesco Giuseppe De Rosa  18   19 , Silvia Corcione  18 , Alessandra Mularoni  20 , Giovanna Russelli  20 , Mauro Giacomini  21 , Flavia Badalucco Ciotta  22 , Chiara Oltolini  22 , Francesco Saverio Serino  23 , Elena Momesso  24 , Michele Spinicci  25   26 , Lucia Graziani  25 , Carlo Torti  27   28 , Enrico Maria Trecarichi  27   28 , Marco Merli  29 , Federico D'Amico  29 , Anna Marchese  5   30 , Antonio Vena  1   2 , Matteo Bassetti  1   2
Affiliations

Mortality in KPC-producing Klebsiella pneumoniae bloodstream infections: a changing landscape

Daniele Roberto Giacobbe et al. J Antimicrob Chemother. .

Abstract

Objectives: 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.

Material and methods: Retrospective study of patients with K. pneumoniae BSI between January and August 2020 in 16 centres (CARBANEW study within the MULTI-SITA project).

Results: 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 < 0.001) and Pitt score (HR 1.33; 95% CI 1.15-1.55, P < 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).

Conclusions: 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.

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