Benefits and Safety of Empiric Antibiotic Treatment Active Against KPC-K. pneumoniae in Febrile Neutropenic Patients with Acute Leukemia Who are Colonized with KPC-K. pneumoniae. A 7-Years Retrospective Observational Cohort Study
Alessandra Micozzi,1 Clara Minotti,2 Saveria Capria,2 Claudio Cartoni,2 Silvia Maria Trisolini,2 Giovanni Manfredi Assanto,1 Walter Barberi,2 Maria Luisa Moleti,2 Stefania Santilli,3 Maurizio Martelli,1 Giuseppe Gentile1 1Haematology, Department of Translational and Precision Medicine, Sapienza Univ...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2023-01-01
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| Series: | Infection and Drug Resistance |
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| Online Access: | https://www.dovepress.com/benefits-and-safety-of-empiric-antibiotic-treatment-active-against-kpc-peer-reviewed-fulltext-article-IDR |
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| author | Micozzi A Minotti C Capria S Cartoni C Trisolini SM Assanto GM Barberi W Moleti ML Santilli S Martelli M Gentile G |
| author_facet | Micozzi A Minotti C Capria S Cartoni C Trisolini SM Assanto GM Barberi W Moleti ML Santilli S Martelli M Gentile G |
| author_sort | Micozzi A |
| collection | DOAJ |
| description | Alessandra Micozzi,1 Clara Minotti,2 Saveria Capria,2 Claudio Cartoni,2 Silvia Maria Trisolini,2 Giovanni Manfredi Assanto,1 Walter Barberi,2 Maria Luisa Moleti,2 Stefania Santilli,3 Maurizio Martelli,1 Giuseppe Gentile1 1Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy; 2Department of Haematology, Oncology and Dermatology, Azienda Policlinico Umberto I, Rome, Italy; 3Department of Diagnostics, Azienda Policlinico Umberto I, Rome, ItalyCorrespondence: Alessandra Micozzi, Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy, Tel +39 6 857951, Fax +39 6 44241984, Email alessandra.micozzi@uniroma1.itPurpose: To evaluate the benefits and safety of the empiric antibiotic treatment (EAT) active against KPC-K. pneumoniae in febrile neutropenic patients with acute leukaemia (AL) who are colonised by KPC-K. pneumoniae.Patients and Methods: A 7-year (2013– 2019) retrospective observational cohort study was conducted at the Haematology, Sapienza Rome University (Italy) on 94 febrile neutropenia episodes (FNE) in AL patients KPC-K. pneumoniae carriers treated with active EAT.Results: Eighty-two (87%) FNE were empirically treated with antibiotic combinations [38 colistin-based and 44 ceftazidime-avibactam (CAZAVI)-based], 12 with CAZAVI monotherapy. Successful outcomes were observed in 88/94 (94%) FNE, 46/49 (94%) microbiologically documented infections, and 24/27 (89%) gram-negative bloodstream infections (GNB-BSI). Mortality due to infective causes was 4.2% (2.1% within 1 week). KPC-K. pneumoniae infections caused 28/94 FNE (30%) and KPC-K. pneumoniae-BSI was documented in 22 FNE (23.4%) (85% of GNB-BSI), in all cases patients received active EAT, and 21 survived. KPC-K.pneumoniae-BSI mortality rate was 4.5%. CAZAVI-based EAT showed better results than colistin-based EAT (55/56 vs 33/38, p = 0.037), overall and without EAT modification (41/56 vs 20/38, p = 0.02). Empirical combinations including CAZAVI were successful in 98% of cases (43/44 vs 33/38 for colistin-based EAT, p = 0.01), without modifications in 82% (36/44 vs 20/28, p = 0.02). All deaths occurred in patients treated with colistin-based EAT (4/38 vs 0/56, p = 0.02). CAZAVI-containing EAT was the only independent factor for an overall successful response (HR 0.058, CI 0.013– 1.072, p = 0.058). Nephrotoxicity occurred in 3(8%) patients undergoing colistin-based EAT (none in those undergoing CAZAVI-based EAT, p = 0.02).Conclusion: KPC-K. pneumoniae infections are frequent in colonised AL patients with FNE. EAT with active antibiotics, mainly CAZAVI-based combinations, was effective, safe, and associated with low overall and KPC-K. pneumoniae-BSI-related mortality.Keywords: ceftazidime-avibactam, colistin, haematological malignancies, KPC-K. pneumoniae-BSI mortality rate |
| first_indexed | 2024-04-10T16:31:59Z |
| format | Article |
| id | doaj.art-0acb65eddce24f13931c4fde8e4f4968 |
| institution | Directory Open Access Journal |
| issn | 1178-6973 |
| language | English |
| last_indexed | 2024-04-10T16:31:59Z |
| publishDate | 2023-01-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Infection and Drug Resistance |
| spelling | doaj.art-0acb65eddce24f13931c4fde8e4f49682023-02-08T22:17:21ZengDove Medical PressInfection and Drug Resistance1178-69732023-01-01Volume 1669570481354Benefits and Safety of Empiric Antibiotic Treatment Active Against KPC-K. pneumoniae in Febrile Neutropenic Patients with Acute Leukemia Who are Colonized with KPC-K. pneumoniae. A 7-Years Retrospective Observational Cohort StudyMicozzi AMinotti CCapria SCartoni CTrisolini SMAssanto GMBarberi WMoleti MLSantilli SMartelli MGentile GAlessandra Micozzi,1 Clara Minotti,2 Saveria Capria,2 Claudio Cartoni,2 Silvia Maria Trisolini,2 Giovanni Manfredi Assanto,1 Walter Barberi,2 Maria Luisa Moleti,2 Stefania Santilli,3 Maurizio Martelli,1 Giuseppe Gentile1 1Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy; 2Department of Haematology, Oncology and Dermatology, Azienda Policlinico Umberto I, Rome, Italy; 3Department of Diagnostics, Azienda Policlinico Umberto I, Rome, ItalyCorrespondence: Alessandra Micozzi, Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy, Tel +39 6 857951, Fax +39 6 44241984, Email alessandra.micozzi@uniroma1.itPurpose: To evaluate the benefits and safety of the empiric antibiotic treatment (EAT) active against KPC-K. pneumoniae in febrile neutropenic patients with acute leukaemia (AL) who are colonised by KPC-K. pneumoniae.Patients and Methods: A 7-year (2013– 2019) retrospective observational cohort study was conducted at the Haematology, Sapienza Rome University (Italy) on 94 febrile neutropenia episodes (FNE) in AL patients KPC-K. pneumoniae carriers treated with active EAT.Results: Eighty-two (87%) FNE were empirically treated with antibiotic combinations [38 colistin-based and 44 ceftazidime-avibactam (CAZAVI)-based], 12 with CAZAVI monotherapy. Successful outcomes were observed in 88/94 (94%) FNE, 46/49 (94%) microbiologically documented infections, and 24/27 (89%) gram-negative bloodstream infections (GNB-BSI). Mortality due to infective causes was 4.2% (2.1% within 1 week). KPC-K. pneumoniae infections caused 28/94 FNE (30%) and KPC-K. pneumoniae-BSI was documented in 22 FNE (23.4%) (85% of GNB-BSI), in all cases patients received active EAT, and 21 survived. KPC-K.pneumoniae-BSI mortality rate was 4.5%. CAZAVI-based EAT showed better results than colistin-based EAT (55/56 vs 33/38, p = 0.037), overall and without EAT modification (41/56 vs 20/38, p = 0.02). Empirical combinations including CAZAVI were successful in 98% of cases (43/44 vs 33/38 for colistin-based EAT, p = 0.01), without modifications in 82% (36/44 vs 20/28, p = 0.02). All deaths occurred in patients treated with colistin-based EAT (4/38 vs 0/56, p = 0.02). CAZAVI-containing EAT was the only independent factor for an overall successful response (HR 0.058, CI 0.013– 1.072, p = 0.058). Nephrotoxicity occurred in 3(8%) patients undergoing colistin-based EAT (none in those undergoing CAZAVI-based EAT, p = 0.02).Conclusion: KPC-K. pneumoniae infections are frequent in colonised AL patients with FNE. EAT with active antibiotics, mainly CAZAVI-based combinations, was effective, safe, and associated with low overall and KPC-K. pneumoniae-BSI-related mortality.Keywords: ceftazidime-avibactam, colistin, haematological malignancies, KPC-K. pneumoniae-BSI mortality ratehttps://www.dovepress.com/benefits-and-safety-of-empiric-antibiotic-treatment-active-against-kpc-peer-reviewed-fulltext-article-IDRceftazidime-avibactamcolistinhaematological malignancieskpc-k.pneumoniae-bsi mortality rate |
| spellingShingle | Micozzi A Minotti C Capria S Cartoni C Trisolini SM Assanto GM Barberi W Moleti ML Santilli S Martelli M Gentile G Benefits and Safety of Empiric Antibiotic Treatment Active Against KPC-K. pneumoniae in Febrile Neutropenic Patients with Acute Leukemia Who are Colonized with KPC-K. pneumoniae. A 7-Years Retrospective Observational Cohort Study Infection and Drug Resistance ceftazidime-avibactam colistin haematological malignancies kpc-k.pneumoniae-bsi mortality rate |
| title | Benefits and Safety of Empiric Antibiotic Treatment Active Against KPC-K. pneumoniae in Febrile Neutropenic Patients with Acute Leukemia Who are Colonized with KPC-K. pneumoniae. A 7-Years Retrospective Observational Cohort Study |
| title_full | Benefits and Safety of Empiric Antibiotic Treatment Active Against KPC-K. pneumoniae in Febrile Neutropenic Patients with Acute Leukemia Who are Colonized with KPC-K. pneumoniae. A 7-Years Retrospective Observational Cohort Study |
| title_fullStr | Benefits and Safety of Empiric Antibiotic Treatment Active Against KPC-K. pneumoniae in Febrile Neutropenic Patients with Acute Leukemia Who are Colonized with KPC-K. pneumoniae. A 7-Years Retrospective Observational Cohort Study |
| title_full_unstemmed | Benefits and Safety of Empiric Antibiotic Treatment Active Against KPC-K. pneumoniae in Febrile Neutropenic Patients with Acute Leukemia Who are Colonized with KPC-K. pneumoniae. A 7-Years Retrospective Observational Cohort Study |
| title_short | Benefits and Safety of Empiric Antibiotic Treatment Active Against KPC-K. pneumoniae in Febrile Neutropenic Patients with Acute Leukemia Who are Colonized with KPC-K. pneumoniae. A 7-Years Retrospective Observational Cohort Study |
| title_sort | benefits and safety of empiric antibiotic treatment active against kpc k pneumoniae in febrile neutropenic patients with acute leukemia who are colonized with kpc k pneumoniae a 7 years retrospective observational cohort study |
| topic | ceftazidime-avibactam colistin haematological malignancies kpc-k.pneumoniae-bsi mortality rate |
| url | https://www.dovepress.com/benefits-and-safety-of-empiric-antibiotic-treatment-active-against-kpc-peer-reviewed-fulltext-article-IDR |
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