Resistance to Ceftazidime/Avibactam in <i>Klebsiella pneumoniae</i> KPC-Producing Isolates: A Real-Life Observational Study
<b>Background:</b> Ceftazidime/avibactam (CAZ-AVI) resistance amongst <i>Enterobacterales</i> is worryingly increasing worldwide. <b>Objectives:</b> The aim of this study was to collect and describe real-life data on CAZ-AVI-resistant <i>Klebsiella pneumonia...
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| Format: | Article |
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MDPI AG
2023-04-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/12/5/820 |
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| author | Laura Campogiani Pietro Vitale Alessandra Lodi Alessandra Imeneo Carla Fontana Cartesio D’Agostini Mirko Compagno Luigi Coppola Ilaria Spalliera Vincenzo Malagnino Elisabetta Teti Marco Iannetta Massimo Andreoni Loredana Sarmati |
| author_facet | Laura Campogiani Pietro Vitale Alessandra Lodi Alessandra Imeneo Carla Fontana Cartesio D’Agostini Mirko Compagno Luigi Coppola Ilaria Spalliera Vincenzo Malagnino Elisabetta Teti Marco Iannetta Massimo Andreoni Loredana Sarmati |
| author_sort | Laura Campogiani |
| collection | DOAJ |
| description | <b>Background:</b> Ceftazidime/avibactam (CAZ-AVI) resistance amongst <i>Enterobacterales</i> is worryingly increasing worldwide. <b>Objectives:</b> The aim of this study was to collect and describe real-life data on CAZ-AVI-resistant <i>Klebsiella pneumoniae</i> (KP) isolates in our University Hospital, with the ultimate goal of evaluating possible risk factors related to the acquisition of resistance. <b>Methods:</b> This is a retrospective observational study, including unique <i>Klebsiella pneumoniae</i> (KP) isolates resistant to CAZ-AVI (CAZ-AVI-R) and producing only KPC, collected from July 2019 to August 2021 at Policlinico Tor Vergata, Rome, Italy. The pathogen’s list was obtained from the microbiology laboratory; clinical charts of the corresponding patients were reviewed to collect demographic and clinical data. Subjects treated as outpatients or hospitalized for <48 h were excluded. Patients were then divided into two groups: S group, if they had a prior isolate of CAZ-AVI-susceptible KP-KPC, and R group, if the first documented isolate of KP-KPC was resistant to CAZ-AVI. <b>Results:</b> Forty-six unique isolates corresponding to 46 patients were included in the study. The majority of patients (60.9%) were hospitalized in an intensive care unit, 32.6% in internal medicine wards and 6.5% in surgical wards. A total of 15 (32.6%) isolates were collected from rectal swabs, representing a colonization. Amongst clinically relevant infections, pneumonia and urinary tract infections were the most commonly found (5/46, 10.9% each). Half of the patients received CAZ-AVI prior to isolation of the KP-KPC CAZ-AVI-R (23/46). This percentage was significantly higher in patients in the S group compared to patients in the R group (69.3% S group vs. 25% R group, <i>p</i> = 0.003). No differences between the two groups were documented in the use of renal replacement therapy or in the infection site. The clinically relevant CAZ-AVI-R KP infections (22/46, 47.8%) were all treated with a combination therapy, 65% including colistin and 55% including CAZ-AVI, with an overall clinical success of 38.1%. <b>Conclusions:</b> Prior use of CAZ-AVI was associated with the emergence of drug resistance. |
| first_indexed | 2024-03-11T04:00:46Z |
| format | Article |
| id | doaj.art-9266472652cb4827987423e877ee0a4e |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-11T04:00:46Z |
| publishDate | 2023-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-9266472652cb4827987423e877ee0a4e2023-11-18T00:11:42ZengMDPI AGAntibiotics2079-63822023-04-0112582010.3390/antibiotics12050820Resistance to Ceftazidime/Avibactam in <i>Klebsiella pneumoniae</i> KPC-Producing Isolates: A Real-Life Observational StudyLaura Campogiani0Pietro Vitale1Alessandra Lodi2Alessandra Imeneo3Carla Fontana4Cartesio D’Agostini5Mirko Compagno6Luigi Coppola7Ilaria Spalliera8Vincenzo Malagnino9Elisabetta Teti10Marco Iannetta11Massimo Andreoni12Loredana Sarmati13Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, ItalyInfectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, ItalyDepartment of System Medicine, Tor Vergata University, 00133 Rome, ItalyDepartment of System Medicine, Tor Vergata University, 00133 Rome, ItalyMicrobiology and BioBank, INMI Lazzaro Spallanzani, 00133 Rome, ItalyLaboratory of Clinical Microbiology, Policlinico Tor Vergata, 00133 Rome, ItalyInfectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, ItalyInfectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, ItalyInfectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, ItalyInfectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, ItalyInfectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, ItalyInfectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, ItalyInfectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, ItalyInfectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy<b>Background:</b> Ceftazidime/avibactam (CAZ-AVI) resistance amongst <i>Enterobacterales</i> is worryingly increasing worldwide. <b>Objectives:</b> The aim of this study was to collect and describe real-life data on CAZ-AVI-resistant <i>Klebsiella pneumoniae</i> (KP) isolates in our University Hospital, with the ultimate goal of evaluating possible risk factors related to the acquisition of resistance. <b>Methods:</b> This is a retrospective observational study, including unique <i>Klebsiella pneumoniae</i> (KP) isolates resistant to CAZ-AVI (CAZ-AVI-R) and producing only KPC, collected from July 2019 to August 2021 at Policlinico Tor Vergata, Rome, Italy. The pathogen’s list was obtained from the microbiology laboratory; clinical charts of the corresponding patients were reviewed to collect demographic and clinical data. Subjects treated as outpatients or hospitalized for <48 h were excluded. Patients were then divided into two groups: S group, if they had a prior isolate of CAZ-AVI-susceptible KP-KPC, and R group, if the first documented isolate of KP-KPC was resistant to CAZ-AVI. <b>Results:</b> Forty-six unique isolates corresponding to 46 patients were included in the study. The majority of patients (60.9%) were hospitalized in an intensive care unit, 32.6% in internal medicine wards and 6.5% in surgical wards. A total of 15 (32.6%) isolates were collected from rectal swabs, representing a colonization. Amongst clinically relevant infections, pneumonia and urinary tract infections were the most commonly found (5/46, 10.9% each). Half of the patients received CAZ-AVI prior to isolation of the KP-KPC CAZ-AVI-R (23/46). This percentage was significantly higher in patients in the S group compared to patients in the R group (69.3% S group vs. 25% R group, <i>p</i> = 0.003). No differences between the two groups were documented in the use of renal replacement therapy or in the infection site. The clinically relevant CAZ-AVI-R KP infections (22/46, 47.8%) were all treated with a combination therapy, 65% including colistin and 55% including CAZ-AVI, with an overall clinical success of 38.1%. <b>Conclusions:</b> Prior use of CAZ-AVI was associated with the emergence of drug resistance.https://www.mdpi.com/2079-6382/12/5/820<i>Klebsiella pneumoniae</i>ceftazidime/avibactammultidrug resistance |
| spellingShingle | Laura Campogiani Pietro Vitale Alessandra Lodi Alessandra Imeneo Carla Fontana Cartesio D’Agostini Mirko Compagno Luigi Coppola Ilaria Spalliera Vincenzo Malagnino Elisabetta Teti Marco Iannetta Massimo Andreoni Loredana Sarmati Resistance to Ceftazidime/Avibactam in <i>Klebsiella pneumoniae</i> KPC-Producing Isolates: A Real-Life Observational Study Antibiotics <i>Klebsiella pneumoniae</i> ceftazidime/avibactam multidrug resistance |
| title | Resistance to Ceftazidime/Avibactam in <i>Klebsiella pneumoniae</i> KPC-Producing Isolates: A Real-Life Observational Study |
| title_full | Resistance to Ceftazidime/Avibactam in <i>Klebsiella pneumoniae</i> KPC-Producing Isolates: A Real-Life Observational Study |
| title_fullStr | Resistance to Ceftazidime/Avibactam in <i>Klebsiella pneumoniae</i> KPC-Producing Isolates: A Real-Life Observational Study |
| title_full_unstemmed | Resistance to Ceftazidime/Avibactam in <i>Klebsiella pneumoniae</i> KPC-Producing Isolates: A Real-Life Observational Study |
| title_short | Resistance to Ceftazidime/Avibactam in <i>Klebsiella pneumoniae</i> KPC-Producing Isolates: A Real-Life Observational Study |
| title_sort | resistance to ceftazidime avibactam in i klebsiella pneumoniae i kpc producing isolates a real life observational study |
| topic | <i>Klebsiella pneumoniae</i> ceftazidime/avibactam multidrug resistance |
| url | https://www.mdpi.com/2079-6382/12/5/820 |
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