title: Carbapenemase-producing Klebsiella pneumoniae bloodstream infections in neutropenic patients with haematological malignancies or aplastic anaemia: Analysis of 50 cases.
abstract: Carbapenemase-producing Klebsiella pneumoniae (CP-Kp) are currently among the most important nosocomial pathogens in many geographic regions. A retrospective study was conducted between 2010 and 2014 in four hospitals located in a high-prevalence area (Athens, Greece) to describe the clinical features, treatment and outcomes of neutropenic patients with haematological diseases complicated with CP-Kp bloodstream infections. A total of 50 patients were identified, including 48 with haematological malignancies and 2 with aplastic anaemia. All patients had neutropenia (<500 cells/mm(3)), of whom 40 had <100 neutrophils/mm(3). The probable source of bacteraemia was identified in 9 patients; in the remaining 41 patients the bacteraemia was considered primary. For definitive treatment, 30 patients received combination therapy (two or more active drugs), 10 received monotherapy (one active drug) and 4 received therapy with no active drug; the remaining 6 patients died within 48 h after the onset of bacteraemia. The 14-day all-cause mortality rate was 50%, 38% and 33% for those who received one, two or three active drugs respectively. In the Cox proportional hazards model, unresolved neutropenia [hazard ratio (HR)=19.28, 95% confidence interval (CI) 2.31-160.69; P=0.006], septic shock (HR=3.04, 95% CI 1.06-8.78; P=0.04) and treatment with one active drug (HR for monotherapy versus combination therapy=3.95, 95% CI 1.23-12.65; P=0.02) were independent predictors of death, whilst combination therapy was associated with lower mortality. These findings may assist physicians in making treatment decisions for neutropenic patients with CP-Kp infections.
authors.affiliation: First Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Polydoros
authors.initials: P
authors.lastname: Tofas
authors.affiliation: First Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Anna
authors.initials: A
authors.lastname: Skiada
authors.affiliation: Department of Hematology, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Angelopoulou
authors.affiliation: Department of Pathophysiology, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Sipsas
authors.affiliation: First Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Pavlopoulou
authors.affiliation: Fifth Department of Medicine, Evangelismos Hospital, Athens, Greece.
authors.forename: Sofia
authors.initials: S
authors.lastname: Tsaousi
authors.affiliation: Department of Hematology, Evangelismos Hospital, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Pagoni
authors.affiliation: Department of Hematology, Metaxa Hospital, Piraeus, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Kotsopoulou
authors.affiliation: Department of Hematology, Metaxa Hospital, Piraeus, Greece.
authors.forename: Stavroula
authors.initials: S
authors.lastname: Perlorentzou
authors.affiliation: Fourth Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Antoniadou
authors.affiliation: Department of Medicine, Hippokrateion Hospital, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Pirounaki
authors.affiliation: Fifth Department of Medicine, Evangelismos Hospital, Athens, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Skoutelis
authors.affiliation: First Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece. Electronic address: gdaikos@med.uoa.gr.
authors.forename: George L
authors.initials: GL
authors.lastname: Daikos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000741:Anemia, Aplastic / Q000150:complications*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D001426:Bacterial Proteins / Q000378:metabolism*; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006115:Greece / Q000453:epidemiology; D019337:Hematologic Neoplasms / Q000150:complications*; D006761:Hospitals; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase
keywords: Carbapenemase; Infection; Klebsiella; Neutropenia