title: Bloodstream infections caused by Klebsiella pneumoniae in onco-hematological patients: clinical impact of carbapenem resistance in a multicentre prospective survey.
abstract: The aim of this study was to identify risk factors for mortality in patients suffering from hematological malignancies (HMs) with bloodstream infections (BSIs) caused by Klebsiella pneumoniae (KP). We conducted a prospective cohort study on KP BSI in 13 Italian hematological units participating in the HEMABIS registry-SEIFEM group. The outcome measured was death within 21 days of BSI onset. Survivor and non-survivor subgroups were compared and Cox regression analysis was conducted to identify independent predictors of mortality. A total of 278 episodes of KP BSI were included in the study between January 2010 and June 2014. We found that 161 (57.9%) KP isolates were carbapenem resistant (CRKP). The overall 21-day mortality rate was 36.3%. It was significantly higher for patients with CRKP BSI (84/161, 52.2%) than for those with BSI caused by carbapenem susceptible KP (CSKP) (17/117, 14.5%; P < 0.001). Septic shock (HR 3.86), acute respiratory failure (HR 2.32), inadequate initial antimicrobial therapy (HR 1.87) and carbapenem resistance by KP isolates (HR 1.85) were independently associated with mortality. A subanalysis was conducted in only 149 patients with CRKP BSI who had received ≥48 hr of adequate antibiotic therapy, and combination therapy was independently associated with survival (HR 0.32). Our study shows that in recent years carbapenem resistance has dramatically increased in HM patients with KP BSI in Italy and is associated with a worse outcome. The optimal management of such infections and the definition of new empirical/targeted antimicrobial strategies in HM patients can still be considered unmet clinical needs. Am. J. Hematol. 91:1076-1081, 2016. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Institute of Infectious Diseases, Policlinico Universitario Agostino Gemelli, Rome, Italy. enricomaria.trecarichi@policlinicogemelli.it.
authors.forename: Enrico Maria
authors.initials: EM
authors.lastname: Trecarichi
authors.affiliation: Institute of Hematology, Policlinico Universitario Agostino Gemelli, Rome, Italy.
authors.forename: Livio
authors.initials: L
authors.lastname: Pagano
authors.affiliation: Haematology, Bianchi Melacrino Morelli Hospital, Reggio Calabria, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Martino
authors.affiliation: Division of Hematology and Stem Cell Transplantation, University Hospital of Udine, Udine, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Candoni
authors.affiliation: Institute of Hematology, Policlinico Universitario Agostino Gemelli, Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Di Blasi
authors.affiliation: Section of Hematology, Department of Clinical and Experimental Medicine, University of Verona, Italy.
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Nadali
authors.affiliation: Institute of Hematology, Policlinico Universitario Agostino Gemelli, Rome, Italy.
authors.forename: Luana
authors.initials: L
authors.lastname: Fianchi
authors.affiliation: Hematology Section, Department of Emergency and Organ Transplant, University of Bari, Bari, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Delia
authors.affiliation: Institute of Hematology, Policlinico Universitario Agostino Gemelli, Rome, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Sica
authors.affiliation: Institute of Hematology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Perriello
authors.affiliation: Department of Hematology and Stem Cell Transplant Unit, AOU Citta' della Salute e della Scienza, Torino, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Busca
authors.affiliation: Hematology and BMT Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Clinical and Experimental Medicine, Hematology and BMT Unit, University of Parma, Parma, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Aversa
authors.affiliation: Haematology Unit, Careggi Hospital and University of Florence, Florence, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Fanci
authors.affiliation: Department of Hematology and Stem Cell Transplant Unit, IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy.
authors.forename: Lorella
authors.initials: L
authors.lastname: Melillo
authors.affiliation: Department of Medicine, Haematology Unit, University of Padova, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Lessi
authors.affiliation: Cattedra di Ematologia, Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Roma, Italy.
authors.forename: Maria Ilaria
authors.initials: MI
authors.lastname: Del Principe
authors.affiliation: Hematology, Spedali Civili, Brescia, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Cattaneo
authors.affiliation: Institute of Infectious Diseases, Policlinico Universitario Agostino Gemelli, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Tumbarello
mesh_terms: D019072:Antibiotic Prophylaxis / Q000401:mortality; D016470:Bacteremia / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D015780:Carbapenems / Q000627:therapeutic use; D015331:Cohort Studies; D004352:Drug Resistance, Microbial; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications* / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007710:Klebsiella Infections / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D007711:Klebsiella pneumoniae; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries
chemical_list: D015780:Carbapenems