Prognostic factors of OXA-48 carbapenemase-producing Klebsiella pneumoniae infection in a tertiary-care Spanish hospital: A retrospective single-center cohort study
Objectives: To describe the determinants of outcome of infections due to oxacillinase-48 (OXA-48) carbapenemase-producing Klebsiella pneumoniae (OXA-48-Kp). Methods: A retrospective cohort study of 117 episodes of OXA-48-Kp infection were conducted. Multivariate Cox models identified factors predict...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-06-01
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| Series: | International Journal of Infectious Diseases |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971222001667 |
| _version_ | 1828344711902920704 |
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| author | Laura Corbella Mario Fernández-Ruiz María Ruiz-Ruigómez Isabel Rodríguez-Goncer José Tiago Silva Pilar Hernández-Jiménez Francisco López-Medrano Manuel Lizasoain Jennifer Villa Octavio Carretero José María Aguado Rafael San-Juan |
| author_facet | Laura Corbella Mario Fernández-Ruiz María Ruiz-Ruigómez Isabel Rodríguez-Goncer José Tiago Silva Pilar Hernández-Jiménez Francisco López-Medrano Manuel Lizasoain Jennifer Villa Octavio Carretero José María Aguado Rafael San-Juan |
| author_sort | Laura Corbella |
| collection | DOAJ |
| description | Objectives: To describe the determinants of outcome of infections due to oxacillinase-48 (OXA-48) carbapenemase-producing Klebsiella pneumoniae (OXA-48-Kp). Methods: A retrospective cohort study of 117 episodes of OXA-48-Kp infection were conducted. Multivariate Cox models identified factors predicting 14-day clinical response and 30-day all-cause mortality. Results: A total of 77 (65.8%) isolates were susceptible to imipenem/meropenem. The 14-day clinical response and 30-day mortality rates were 41.9% and 28.2%. Catheter-related bloodstream infection (adjusted hazard ratio [aHR]: 8.33; 95% confidence interval [95%CI]: 3.19-21.72; P-value <0.001), urinary tract infection (aHR: 3.04; 95%CI: 1.39-6.66; P-value = 0.006) and early appropriate treatment (aHR: 1.77; 95%CI: 0.97-3.22; P-value = 0.064) predicted clinical response, whereas severe sepsis had a deleterious impact (aHR: 0.22; 95%CI: 0.10-0.50; P-value <0.001). Lower respiratory tract infection (aHR: 6.58; 95%CI: 2.83-15.29; P-value <0.001) and bloodstream infection (aHR: 2.33; 95%CI: 1.05-5.15; P-value = 0.037) were associated with 30-day mortality, whereas definitive therapy including ≥1 active agent (aHR: 0.26; 95%CI: 0.11-0.63; P-value = 0.003) and source control (aHR: 0.35; 95%CI: 0.14-0.91; P-value = 0.030) were protective. Combination therapy did not seem to be associated with better outcomes. Conclusions: Appropriate antimicrobial treatment was protective for 30-day mortality in OXA-48-Kp infections. Carbapenems are usually active, whereas combination therapy appeared not to confer additional benefit. |
| first_indexed | 2024-04-14T00:01:25Z |
| format | Article |
| id | doaj.art-8b16a62a9a8a49e986dd6d59a44ac847 |
| institution | Directory Open Access Journal |
| issn | 1201-9712 |
| language | English |
| last_indexed | 2024-04-14T00:01:25Z |
| publishDate | 2022-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj.art-8b16a62a9a8a49e986dd6d59a44ac8472022-12-22T02:23:42ZengElsevierInternational Journal of Infectious Diseases1201-97122022-06-011195968Prognostic factors of OXA-48 carbapenemase-producing Klebsiella pneumoniae infection in a tertiary-care Spanish hospital: A retrospective single-center cohort studyLaura Corbella0Mario Fernández-Ruiz1María Ruiz-Ruigómez2Isabel Rodríguez-Goncer3José Tiago Silva4Pilar Hernández-Jiménez5Francisco López-Medrano6Manuel Lizasoain7Jennifer Villa8Octavio Carretero9José María Aguado10Rafael San-Juan11Unit of Infectious Diseases, Hospital Universitario ''12 de Octubre'', Instituto de Investigación Sanitaria Hospital ''12 de Octubre'' (imas12), Madrid, Spain; Department of Medicine, Complutense University, Madrid, Spain; Corresponding author: Laura Corbella, MD. Unit of Infectious Diseases, Hospital Universitario ''12 de Octubre''. Centro de Actividades Ambulatorias, 2ª planta, bloque D. Avda. de Córdoba, s/n. Postal code 28041. Madrid, Spain. Phone: +34 913908000. Fax: +34 914695775.Unit of Infectious Diseases, Hospital Universitario ''12 de Octubre'', Instituto de Investigación Sanitaria Hospital ''12 de Octubre'' (imas12), Madrid, Spain; Department of Medicine, Complutense University, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFECT), Madrid, SpainUnit of Infectious Diseases, Hospital Universitario ''12 de Octubre'', Instituto de Investigación Sanitaria Hospital ''12 de Octubre'' (imas12), Madrid, Spain; Department of Medicine, Complutense University, Madrid, SpainUnit of Infectious Diseases, Hospital Universitario ''12 de Octubre'', Instituto de Investigación Sanitaria Hospital ''12 de Octubre'' (imas12), Madrid, Spain; Department of Medicine, Complutense University, Madrid, SpainUnit of Infectious Diseases, Hospital Universitario ''12 de Octubre'', Instituto de Investigación Sanitaria Hospital ''12 de Octubre'' (imas12), Madrid, Spain; Department of Medicine, Complutense University, Madrid, SpainUnit of Infectious Diseases, Hospital Universitario ''12 de Octubre'', Instituto de Investigación Sanitaria Hospital ''12 de Octubre'' (imas12), Madrid, Spain; Department of Medicine, Complutense University, Madrid, SpainUnit of Infectious Diseases, Hospital Universitario ''12 de Octubre'', Instituto de Investigación Sanitaria Hospital ''12 de Octubre'' (imas12), Madrid, Spain; Department of Medicine, Complutense University, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFECT), Madrid, SpainUnit of Infectious Diseases, Hospital Universitario ''12 de Octubre'', Instituto de Investigación Sanitaria Hospital ''12 de Octubre'' (imas12), Madrid, Spain; Department of Medicine, Complutense University, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFECT), Madrid, SpainDepartment of Microbiology, Hospital Universitario ''12 de Octubre'', Instituto de Investigación Sanitaria Hospital ''12 de Octubre'' (imas12), Madrid, SpainUnit of Infectious Diseases, Hospital Universitario ''12 de Octubre'', Instituto de Investigación Sanitaria Hospital ''12 de Octubre'' (imas12), Madrid, Spain; Department of Medicine, Complutense University, Madrid, SpainUnit of Infectious Diseases, Hospital Universitario ''12 de Octubre'', Instituto de Investigación Sanitaria Hospital ''12 de Octubre'' (imas12), Madrid, Spain; Department of Medicine, Complutense University, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFECT), Madrid, SpainUnit of Infectious Diseases, Hospital Universitario ''12 de Octubre'', Instituto de Investigación Sanitaria Hospital ''12 de Octubre'' (imas12), Madrid, Spain; Department of Medicine, Complutense University, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFECT), Madrid, SpainObjectives: To describe the determinants of outcome of infections due to oxacillinase-48 (OXA-48) carbapenemase-producing Klebsiella pneumoniae (OXA-48-Kp). Methods: A retrospective cohort study of 117 episodes of OXA-48-Kp infection were conducted. Multivariate Cox models identified factors predicting 14-day clinical response and 30-day all-cause mortality. Results: A total of 77 (65.8%) isolates were susceptible to imipenem/meropenem. The 14-day clinical response and 30-day mortality rates were 41.9% and 28.2%. Catheter-related bloodstream infection (adjusted hazard ratio [aHR]: 8.33; 95% confidence interval [95%CI]: 3.19-21.72; P-value <0.001), urinary tract infection (aHR: 3.04; 95%CI: 1.39-6.66; P-value = 0.006) and early appropriate treatment (aHR: 1.77; 95%CI: 0.97-3.22; P-value = 0.064) predicted clinical response, whereas severe sepsis had a deleterious impact (aHR: 0.22; 95%CI: 0.10-0.50; P-value <0.001). Lower respiratory tract infection (aHR: 6.58; 95%CI: 2.83-15.29; P-value <0.001) and bloodstream infection (aHR: 2.33; 95%CI: 1.05-5.15; P-value = 0.037) were associated with 30-day mortality, whereas definitive therapy including ≥1 active agent (aHR: 0.26; 95%CI: 0.11-0.63; P-value = 0.003) and source control (aHR: 0.35; 95%CI: 0.14-0.91; P-value = 0.030) were protective. Combination therapy did not seem to be associated with better outcomes. Conclusions: Appropriate antimicrobial treatment was protective for 30-day mortality in OXA-48-Kp infections. Carbapenems are usually active, whereas combination therapy appeared not to confer additional benefit.http://www.sciencedirect.com/science/article/pii/S1201971222001667carbapenemasesOXA-48Klebsiella pneumoniaecombination therapyprognostic factors |
| spellingShingle | Laura Corbella Mario Fernández-Ruiz María Ruiz-Ruigómez Isabel Rodríguez-Goncer José Tiago Silva Pilar Hernández-Jiménez Francisco López-Medrano Manuel Lizasoain Jennifer Villa Octavio Carretero José María Aguado Rafael San-Juan Prognostic factors of OXA-48 carbapenemase-producing Klebsiella pneumoniae infection in a tertiary-care Spanish hospital: A retrospective single-center cohort study International Journal of Infectious Diseases carbapenemases OXA-48 Klebsiella pneumoniae combination therapy prognostic factors |
| title | Prognostic factors of OXA-48 carbapenemase-producing Klebsiella pneumoniae infection in a tertiary-care Spanish hospital: A retrospective single-center cohort study |
| title_full | Prognostic factors of OXA-48 carbapenemase-producing Klebsiella pneumoniae infection in a tertiary-care Spanish hospital: A retrospective single-center cohort study |
| title_fullStr | Prognostic factors of OXA-48 carbapenemase-producing Klebsiella pneumoniae infection in a tertiary-care Spanish hospital: A retrospective single-center cohort study |
| title_full_unstemmed | Prognostic factors of OXA-48 carbapenemase-producing Klebsiella pneumoniae infection in a tertiary-care Spanish hospital: A retrospective single-center cohort study |
| title_short | Prognostic factors of OXA-48 carbapenemase-producing Klebsiella pneumoniae infection in a tertiary-care Spanish hospital: A retrospective single-center cohort study |
| title_sort | prognostic factors of oxa 48 carbapenemase producing klebsiella pneumoniae infection in a tertiary care spanish hospital a retrospective single center cohort study |
| topic | carbapenemases OXA-48 Klebsiella pneumoniae combination therapy prognostic factors |
| url | http://www.sciencedirect.com/science/article/pii/S1201971222001667 |
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