title: Carbapenemase-producing Klebsiella pneumoniae bloodstream infection in critically ill patients: risk factors and predictors of mortality.
abstract: A significant increase in carbapenemase-producing Klebsiella pneumoniae (CP-Kp) bacteraemias has been observed worldwide. The objective of the present work was to study the risk factors and predictors of mortality of CP-Kp bacteraemias among critically ill patients. During a 4-year period (2012-3015), a matched 1:2 case-control study was conducted. Klebsiella pneumoniae was identified by Vitek 2 technology. Antibiotic susceptibility was performed by the agar disc diffusion method and Etest. The presence of the blaKPC, blaVIMand blaNDMgenes was confirmed by polymerase chain reaction (PCR). Epidemiologic data were collected from the intensive care unit (ICU) computerised database. One hundred and thirty-nine patients who developed a CP-Kp bacteraemia were matched with 278 patients. The majority of isolates (128; 92.1%) carried the blaKPCgene, seven carried both blaKPCand blaVIM, three blaVIMand one carried blaNDM. Risk factors for the development of CP-Kp bacteraemia were administration of tigecycline and number of antibiotics administered prior to CP-Kp bacteraemia. Overall, the 30-day mortality was 36.0%. Multivariate analysis revealed septic shock, Simplified Acute Physiology Score II (SAPS II) upon infection onset, adjunctive corticosteroid administration and parenteral nutrition as independent predictors of mortality, while treatment with a combination of appropriate antibiotics was identified as a predictor of good prognosis. Among septic shock patients (n = 74), Sequential Organ Failure Assessment (SOFA) score upon infection onset, adjunctive corticosteroid administration and strain carrying the blaKPCgene were independently associated with mortality, while the administration of combination treatment was identified as a predictor of a good prognosis. The administration of tigecycline predisposes to the induction of bacteraemia. Appropriate antibiotic treatment is associated with better survival, while concomitant corticosteroid treatment is associated with mortality.
authors.affiliation: Division of Infectious Diseases, Internal Medicine, School of Medicine, University of Patras, 26504, Rion, Patras, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Papadimitriou-Olivgeris
authors.affiliation: Anesthesiology and Critical Care Medicine, School of Medicine, University of Patras, Rion, Patras, Greece.
authors.forename: F
authors.initials: F
authors.lastname: Fligou
authors.affiliation: Department of Microbiology, School of Medicine, University of Patras, Rion, Patras, Greece.
authors.forename: C
authors.initials: C
authors.lastname: Bartzavali
authors.affiliation: Anesthesiology and Critical Care Medicine, School of Medicine, University of Patras, Rion, Patras, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Zotou
authors.affiliation: Department of Microbiology, School of Medicine, University of Patras, Rion, Patras, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Spyropoulou
authors.affiliation: Anesthesiology and Critical Care Medicine, School of Medicine, University of Patras, Rion, Patras, Greece.
authors.forename: K
authors.initials: K
authors.lastname: Koutsileou
authors.affiliation: Department of Microbiology, School of Medicine, University of Patras, Rion, Patras, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Vamvakopoulou
authors.affiliation: Anesthesiology and Critical Care Medicine, School of Medicine, University of Patras, Rion, Patras, Greece.
authors.forename: N
authors.initials: N
authors.lastname: Sioulas
authors.affiliation: Anesthesiology and Critical Care Medicine, School of Medicine, University of Patras, Rion, Patras, Greece.
authors.forename: V
authors.initials: V
authors.lastname: Karamouzos
authors.affiliation: Department of Microbiology, School of Medicine, University of Patras, Rion, Patras, Greece.
authors.forename: E D
authors.initials: ED
authors.lastname: Anastassiou
authors.affiliation: Department of Microbiology, School of Medicine, University of Patras, Rion, Patras, Greece.
authors.forename: I
authors.initials: I
authors.lastname: Spiliopoulou
authors.affiliation: Department of Microbiology, School of Medicine, University of Patras, Rion, Patras, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Christofidou
authors.affiliation: Division of Infectious Diseases, Internal Medicine, School of Medicine, University of Patras, 26504, Rion, Patras, Greece. mmarangos@yahoo.com.
authors.forename: M
authors.initials: M
authors.lastname: Marangos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001426:Bacterial Proteins / Q000235:genetics / Q000378:metabolism*; D016022:Case-Control Studies; D016638:Critical Illness; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality*; D007711:Klebsiella pneumoniae / Q000201:enzymology / Q000302:isolation & purification*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality*; D016019:Survival Analysis; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase