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Article

Mortality of Pandrug-Resistant Klebsiella pneumoniae Bloodstream Infections in Critically Ill Patients: A Retrospective Cohort of 115 Episodes

1
Division of Infectious Diseases, School of Medicine, University of Patras, 26504 Patras, Greece
2
Department of Microbiology, School of Medicine, University of Patras, 26504 Patras, Greece
3
Anesthesiology and Critical Care Medicine, School of Medicine, University of Patras, 26504 Patras, Greece
*
Author to whom correspondence should be addressed.
Present address: Infectious Diseases Service, Lausanne University Hospital, 1011, Lausanne, Switzerland.
Received: 24 November 2020 / Revised: 5 January 2021 / Accepted: 12 January 2021 / Published: 15 January 2021
(This article belongs to the Special Issue Antimicrobial Resistance: The Final Frontier)
Background: The increased frequency of bacteraemias caused by pandrug-resistant Klebsiella pneumoniae (PDR-Kp) has significant implications. The aim of the present study was to identify predictors associated with mortality of PDR-Kp bacteraemias. Methods: Patients with monomicrobial bacteraemia due to PDR-Kp were included. K. pneumoniae was considered PDR if it showed resistance to all available groups of antibiotics. Primary outcome was 30-day mortality. Minimum inhibitory concentrations (MICs) of meropenem, tigecycline, fosfomycin, and ceftazidime/avibactam were determined by Etest, whereas for colistin, the broth microdilution method was applied. blaKPC, blaVIM, blaNDM, and blaOXA genes were detected by PCR. Results: Among 115 PDR-Kp bacteraemias, the majority of infections were primary bacteraemias (53; 46.1%), followed by catheter-related (35; 30.4%). All isolates were resistant to tested antimicrobials. blaKPC was the most prevalent carbapenemase gene (98 isolates; 85.2%). Thirty-day mortality was 39.1%; among 51 patients with septic shock, 30-day mortality was 54.9%. Multivariate analysis identified the development of septic shock, Charlson comorbidity index, and bacteraemia other than primary or catheter-related as independent predictors of mortality, while a combination of at least three antimicrobials was identified as an independent predictor of survival. Conclusions: Mortality of PDR-Kp bloodstream infections was high. Administration of at least three antimicrobials might be beneficial for infections in critically ill patients caused by such pathogens. View Full-Text
Keywords: intensive care unit (ICU); bacteraemia; carbapenemase; carbapenem-resistance; pandrug-resistance intensive care unit (ICU); bacteraemia; carbapenemase; carbapenem-resistance; pandrug-resistance
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MDPI and ACS Style

Papadimitriou-Olivgeris, M.; Bartzavali, C.; Georgakopoulou, A.; Kolonitsiou, F.; Papamichail, C.; Spiliopoulou, I.; Christofidou, M.; Fligou, F.; Marangos, M. Mortality of Pandrug-Resistant Klebsiella pneumoniae Bloodstream Infections in Critically Ill Patients: A Retrospective Cohort of 115 Episodes. Antibiotics 2021, 10, 76. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics10010076

AMA Style

Papadimitriou-Olivgeris M, Bartzavali C, Georgakopoulou A, Kolonitsiou F, Papamichail C, Spiliopoulou I, Christofidou M, Fligou F, Marangos M. Mortality of Pandrug-Resistant Klebsiella pneumoniae Bloodstream Infections in Critically Ill Patients: A Retrospective Cohort of 115 Episodes. Antibiotics. 2021; 10(1):76. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics10010076

Chicago/Turabian Style

Papadimitriou-Olivgeris, Matthaios, Christina Bartzavali, Alexandra Georgakopoulou, Fevronia Kolonitsiou, Chrisavgi Papamichail, Iris Spiliopoulou, Myrto Christofidou, Fotini Fligou, and Markos Marangos. 2021. "Mortality of Pandrug-Resistant Klebsiella pneumoniae Bloodstream Infections in Critically Ill Patients: A Retrospective Cohort of 115 Episodes" Antibiotics 10, no. 1: 76. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics10010076

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