title: Infection with Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae in cancer patients.
abstract: Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-Kp) is an emergent pathogen in healthcare-associated infections (HAIs). The aim of this study was to describe HAIs due to KPC-Kp, as well as identify mortality risk factors in cancer patients. In patients diagnosed with HAIs due to KPC-Kp between January 2009 and July 2013, we evaluated only the first infection episode of each patient, analyzing mortality separately for patients treated for ≥48 h with at least one antimicrobial agent proven to display in vitro activity against KPC-Kp. We evaluated variables related to the malignancy, the severity and characteristics of the HAI, and the antimicrobial therapy. We identified 83 HAIs due to KPC-Kp. The 30-day mortality was 57.8 % for all infections and 72.7 % for bacteremic infections. Of the 83 patients, 60 patients received ≥48 h of appropriate treatment and 44 (53 %) developed bacteremia. Ten patients (12 %) were neutropenic at HAI diagnosis and 33 (39.8 %) had infection at the tumor site. The most common HAI was urinary tract infection, seen in 26 patients (31.3 %), followed by primary bloodstream infection, seen in 24 patients (28.9 %). Forty-four patients (73.3 %) received combination antimicrobial therapy, most often including polymyxin (68.3 %). Risk factors for 30-day mortality are high sequential organ failure assessment (SOFA) score, need for intensive care stay at diagnosis of infection, and acute kidney injury; the removal of invasive devices related to infection and treatment with effective antibiotics for KPC-Kp are protective factors. In cancer patients, high mortality is associated with HAI due to KPC-Kp and mortality risk factors are more often related to acute infection than to the underlying disease.
authors.affiliation: Hospital Control Infection and Infectious Diseases Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, 01246-000, Brazil.
authors.forename: M P
authors.initials: MP
authors.lastname: Freire
authors.forename: L C
authors.initials: LC
authors.lastname: Pierrotti
authors.forename: H H C
authors.initials: HH
authors.lastname: Filho
authors.forename: K Y
authors.initials: KY
authors.lastname: Ibrahim
authors.forename: A S G K
authors.initials: AS
authors.lastname: Magri
authors.forename: P R
authors.initials: PR
authors.lastname: Bonazzi
authors.forename: L
authors.initials: L
authors.lastname: Hajar
authors.forename: M P E
authors.initials: MP
authors.lastname: Diz
authors.forename: J
authors.initials: J
authors.lastname: Pereira
authors.forename: P M
authors.initials: PM
authors.lastname: Hoff
authors.forename: E
authors.initials: E
authors.lastname: Abdala
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia; D001426:Bacterial Proteins / Q000378:metabolism*; D003428:Cross Infection; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000201:enzymology*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D012307:Risk Factors; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase