title: Prospective observational study of the impact of VIM-1 metallo-beta-lactamase on the outcome of patients with Klebsiella pneumoniae bloodstream infections.
abstract: VIM-1-producing Klebsiella pneumoniae (VPKP) is an emerging pathogen. A prospective observational study was conducted to evaluate the importance of VIM production on outcome of patients with K. pneumoniae bloodstream infections (BSIs). Consecutive patients with K. pneumoniae BSIs were identified and followed up until patient discharge or death. A total of 162 patients were included in the analysis; 67 (41.4%) were infected with VPKP, and 95 were infected with non-VPKP. Fourteen of the patients infected with VPKP were carbapenem resistant (Carb(r)) (MIC > 4 mug/ml), whereas none of the non-VPKP exhibited carbapenem resistance. The patients infected with a Carb(r) organism were more likely (odds ratio, 4.08; 95% confidence interval [CI], 1.29 to 12.85; P = 0.02) to receive inappropriate empirical therapy. The all-cause 14-day mortality rates were 15.8% (15 of 95) for patients infected with VIM-negative organisms, 18.9% (10 of 53) for those infected with VIM-positive carbapenem-susceptible organisms, and 42.9% (6 of 14) for those infected with VIM-positive Carb(r) organisms (P = 0.044). In Cox regression analysis, age (hazard ratio [HR], 1.03; 95% CI, 1.01 to 1.06; P = 0.021), rapidly fatal underlying disease (HR, 2.84; 95% CI, 1.26 to 6.39; P = 0.012), and carbapenem resistance (HR, 2.83; 95% CI, 1.08 to 7.41; P = 0.035) were independent predictors of death. After adjustment for inappropriate empirical or definitive therapy, the effect of carbapenem resistance on outcome was reduced to a level of nonsignificance. In patients with K. pneumoniae BSIs, carbapenem resistance, advanced, age, and severity of underlying disease were independent predictors of outcome, whereas VIM production had no effect on mortality. The higher mortality associated with carbapenem resistance was probably mediated by the failure to provide effective therapy.
authors.affiliation: First Department of Propaedeutic Medicine, University of Athens, Athens 115-26, Greece. gdaikos@med.uoa.gr
authors.forename: George L
authors.initials: GL
authors.lastname: Daikos
authors.forename: Panayiotis
authors.initials: P
authors.lastname: Petrikkos
authors.forename: Mina
authors.initials: M
authors.lastname: Psichogiou
authors.forename: Chris
authors.initials: C
authors.lastname: Kosmidis
authors.forename: Evangelos
authors.initials: E
authors.lastname: Vryonis
authors.forename: Athanasios
authors.initials: A
authors.lastname: Skoutelis
authors.forename: Kleoniki
authors.initials: K
authors.lastname: Georgousi
authors.forename: Leonidas S
authors.initials: LS
authors.lastname: Tzouvelekis
authors.forename: Panayotis T
authors.initials: PT
authors.lastname: Tassios
authors.forename: Christina
authors.initials: C
authors.lastname: Bamia
authors.forename: George
authors.initials: G
authors.lastname: Petrikkos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D015780:Carbapenems / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; C417264:VIM-1 metallo-beta-lactamase; D001618:beta-Lactamases