title: Predictors of outcome in ICU patients with septic shock caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae.
abstract: The aim of this study was to identify factors associated with mortality in intensive care unit patients with Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) septic shock. A retrospective analysis of intensive care unit patients with KPC-Kp infection and septic shock observed in a large teaching hospital from November 2010 to December 2014 was performed. A total of 111 patients were included in the study. The most frequent source of infection was unknown-focus bacteraemia in 53 patients (47.7%). The rate of resistance to colistin was 51.3%; 30-day mortality was reported for 44 patients (39.6%). Surviving patients were more frequently treated with an initial therapy (within 24 hours) including two or more antibiotics displaying in vitro activity against the isolated KPC-Kp strain (41.8 vs. 18.1%, p 0.01) and were also more likely to receive a definitive therapy including two or more in vitro active antibiotics (85.1 vs. 15.9%, p <0.001). Cox regression analysis revealed that a colistin-containing antibiotic regimen (hazard ratio (HR) 0.21, confidence interval (CI) 95% 0.05-0.72, p <0.001), use of two or more in vitro active antibiotics as definite therapy (HR 0.08, CI 95% 0.02-0.21, p <0.001) and control of removable source of infection (HR 0.14, CI 95% 0.04-0.25, p <0.001) were associated with favourable outcome; colistin resistance (HR 8.09, CI 95% 3.14-11.23, p 0.001) and intra-abdominal source of infection (HR 2.92, CI 95% 2.11-4.12, p 0.002) were associated with death. In conclusion, use of a definitive therapy with at least two antibiotics displaying in vitro activity against the KPC-Kp isolates was the most important determinant of favourable outcome, whilst isolation of colistin-resistant strains was associated with death in septic patients with KPC-Kp infection.
authors: Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Italy.
authors: M
authors: M
authors: Falcone
authors: Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Italy.
authors: A
authors: A
authors: Russo
authors: Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Italy.
authors: A
authors: A
authors: Iacovelli
authors: Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Italy.
authors: G
authors: G
authors: Restuccia
authors: Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Italy.
authors: G
authors: G
authors: Ceccarelli
authors: Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Italy.
authors: A
authors: A
authors: Giordano
authors: Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Italy.
authors: A
authors: A
authors: Farcomeni
authors: Department of Anesthesiology and Intensive Care, Policlinico Umberto I, "Sapienza" University of Rome, Italy.
authors: A
authors: A
authors: Morelli
authors: Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Italy. Electronic address: mario.venditti@uniroma1.it.
authors: M
authors: M
authors: Venditti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001426:Bacterial Proteins / Q000378:metabolism*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012772:Shock, Septic / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D016019:Survival Analysis; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase
keywords: Adequate source control; KPC-Kp; carbapenem-resistant Klebsiella pneumoniae strain; colistin-resistance; septic shock