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Bloodstream infections caused by Klebsiella pneumoniae in onco-hematological patients: clinical impact of carbapenem resistance in a multicentre prospective survey.
Trecarichi, Enrico Maria; Pagano, Livio; Martino, Bruno; Candoni, Anna; Di Blasi, Roberta; Nadali, Gianpaolo; Fianchi, Luana; Delia, Mario; Sica, Simona; Perriello, Vincenzo; Busca, Alessandro; Aversa, Franco; Fanci, Rosa; Melillo, Lorella; Lessi, Federica; Del Principe, Maria Ilaria; Cattaneo, Chiara; Tumbarello, Mario.
Afiliación
  • Trecarichi EM; Institute of Infectious Diseases, Policlinico Universitario Agostino Gemelli, Rome, Italy. enricomaria.trecarichi@policlinicogemelli.it.
  • Pagano L; Institute of Hematology, Policlinico Universitario Agostino Gemelli, Rome, Italy.
  • Martino B; Haematology, Bianchi Melacrino Morelli Hospital, Reggio Calabria, Italy.
  • Candoni A; Division of Hematology and Stem Cell Transplantation, University Hospital of Udine, Udine, Italy.
  • Di Blasi R; Institute of Hematology, Policlinico Universitario Agostino Gemelli, Rome, Italy.
  • Nadali G; Section of Hematology, Department of Clinical and Experimental Medicine, University of Verona, Italy.
  • Fianchi L; Institute of Hematology, Policlinico Universitario Agostino Gemelli, Rome, Italy.
  • Delia M; Hematology Section, Department of Emergency and Organ Transplant, University of Bari, Bari, Italy.
  • Sica S; Institute of Hematology, Policlinico Universitario Agostino Gemelli, Rome, Italy.
  • Perriello V; Institute of Hematology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
  • Busca A; Department of Hematology and Stem Cell Transplant Unit, AOU Citta' della Salute e della Scienza, Torino, Italy.
  • Aversa F; 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.
  • Fanci R; Haematology Unit, Careggi Hospital and University of Florence, Florence, Italy.
  • Melillo L; Department of Hematology and Stem Cell Transplant Unit, IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy.
  • Lessi F; Department of Medicine, Haematology Unit, University of Padova, Italy.
  • Del Principe MI; Cattedra di Ematologia, Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Roma, Italy.
  • Cattaneo C; Hematology, Spedali Civili, Brescia, Italy.
  • Tumbarello M; Institute of Infectious Diseases, Policlinico Universitario Agostino Gemelli, Rome, Italy.
Am J Hematol ; 91(11): 1076-1081, 2016 Nov.
Article en En | MEDLINE | ID: mdl-27428072
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infecciones por Klebsiella / Bacteriemia / Neoplasias Hematológicas Tipo de estudio: Clinical_trials / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Am J Hematol Año: 2016 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infecciones por Klebsiella / Bacteriemia / Neoplasias Hematológicas Tipo de estudio: Clinical_trials / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Am J Hematol Año: 2016 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Estados Unidos