Rapid diagnostics and ceftazidime/avibactam for KPC-producing Klebsiella pneumoniae bloodstream infections: impact on mortality and role of combination therapy

Matteo Boattini, Gabriele Bianco, Lorena Charrier, Sara Comini, Marco Iannaccone, André Almeida, Rossana Cavallo, Francesco Giuseppe De Rosa, Cristina Costa

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)

Abstract

This study was aimed at investigating risk factors for mortality in patients suffering from KPC-producing Klebsiella pneumoniae (KPC-Kp) bloodstream infections (BSIs), evaluating the impact of rapid diagnostics and ceftazidime/avibactam use. This observational retrospective study (January 2017–May 2021) included all patients with a KPC-Kp BSI. Uni-multivariable analyses were carried out to evaluate the effect of clinical variables on both in-hospital death (IHD) and 30-day all-cause mortality, and the role of the combination of ceftazidime/avibactam plus polymyxin. One hundred and ninety-six patients met the study’s inclusion criteria. Older age, having undergone renal replacement therapy during the 30 days preceding the KPC-Kp BSI onset, having an INCREMENT-CPE score ≥ 8, and having suffered from a superimposed and/or following KPC-Kp BSI treatment candidemia were found to be the main factors associated with both mortality rates. Among protective factors, the centrality of ceftazidime/avibactam in monotherapy (IHD: OR: 0.34; CI 95%: 0.11–1.00—30-day all-cause mortality: OR: 0.18; CI 95%: 0.04–0.77) or combination (IHD: OR: 0.51; CI 95%: 0.22–1.19—30-day all-cause mortality: OR: 0.62; CI 95%: 0.21–1.84) emerged and became even more evident once the effect of ceftazidime/avibactam plus polymyxin was removed. Rapid diagnostics may be useful to adopt more effective strategies for the treatment of KPC-Kp BSI patients and implement infection control measures, even if not associated with higher patient survival. Ceftazidime/avibactam, even when used alone, represents an important option against KPC-Kp, while combined use with polymyxin might not have altered its efficacy. Patient comorbidities, severity of BSI, and complications such as candidemia were confirmed to have a significant burden on survival.

Original languageEnglish
Pages (from-to)431 - 439
JournalEuropean Journal of Clinical Microbiology and Infectious Diseases
Volume42
Issue number4
Early online date20 Feb 2023
DOIs
Publication statusPublished - Apr 2023

Keywords

  • Bloodstream infection
  • Carbapenemase
  • Ceftazidime-avibactam
  • Klebsiella pneumoniae
  • KPC
  • Rapid diagnostic test
  • Sepsis

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