Infectious Disease Unit, Internal Medicine Department, University Hospital Complex of Vigo.
Biomedical Research Institute Galicia Sur.
Medicine (Baltimore). 2021 Apr 9;100(14):e24880. doi: 10.1097/MD.0000000000024880.
Carbapenemase-producing Enterobacterales constitute a serious public health threat; however, information on the oxacilinasa (OXA-48)-type is limited. The objective of the study was to evaluate the risk factors associated with 14-day mortality for patients with bacteremia due to OXA-48 carbapenemase-producing Klebsiella pneumoniae.We conducted a retrospective, single-center observational study of adult patients with K. pneumoniae bacteremia, classifying the strains as carbapenem-susceptible K. pneumoniae (CSKp) and carbapenem-resistant K. pneumoniae (CRKp). All of the CRKp strains were the OXA-48-type.The study included 202 cases of bacteremia: 114 due to CSKp and 88 due to CRKp. The clinical cure rate was higher for the patients with CSKp (85% vs 69% for CSKp and CRKp, respectively; P = .010), while the 14-day mortality rate was lower (13% vs 30%, P = .005). An INCREMENT-CPE score ≥7 (HR 3.05, 95% CI 1.50-6.25, P = .002) was the only independent factor associated with 14-day mortality for the patients with Klebsiella spp. bacteremia. Other factors related to 14-day mortality were a rapidly fatal prognosis (McCabe) (HR 7.1, 95% CI 2.75-18.37, P < .001), dementia (HR 5.9, 95% CI 2.0-7.43, P = .001), and a high-risk source of infection (HR 2.7, 95% CI 1.06-6.82, P = .038).The most important factors associated with 14-day mortality for the patients with K. pneumoniae bacteremia was an INCREMENT-CPE score ≥7, dementia, a McCabe score indicating a rapidly fatal prognosis and a high-risk source of infection. We found no relationship between a poorer outcome and CRKp isolation or inadequate antibiotic therapy.
产碳青霉烯酶肠杆菌科构成了严重的公共卫生威胁；然而，关于耐氧西林克拉维酸（OXA-48）型的信息有限。本研究的目的是评估耐碳青霉烯类肺炎克雷伯菌（CRKP）血流感染患者 14 天死亡率的相关危险因素。我们进行了一项回顾性、单中心观察性研究，纳入了成人耐碳青霉烯类肺炎克雷伯菌血流感染患者，将菌株分为耐碳青霉烯类肺炎克雷伯菌（CSKP）和耐碳青霉烯类肺炎克雷伯菌（CRKP）。所有 CRKP 株均为 OXA-48 型。本研究共纳入 202 例血流感染患者：114 例为 CSKP，88 例为 CRKP。CSKP 患者的临床治愈率较高（分别为 85%和 69%，P = 0.010），而 14 天死亡率较低（分别为 13%和 30%，P = 0.005）。INCREMENT-CPE 评分≥7（HR 3.05，95%CI 1.50-6.25，P = 0.002）是耐碳青霉烯类肺炎克雷伯菌血流感染患者 14 天死亡率的唯一独立危险因素。其他与 14 天死亡率相关的因素包括快速致命预后（McCabe）（HR 7.1，95%CI 2.75-18.37，P < 0.001）、痴呆（HR 5.9，95%CI 2.0-7.43，P = 0.001）和高风险感染源（HR 2.7，95%CI 1.06-6.82，P = 0.038）。耐碳青霉烯类肺炎克雷伯菌血流感染患者 14 天死亡率的最重要因素是 INCREMENT-CPE 评分≥7、痴呆、预示快速致命预后的 McCabe 评分和高风险感染源。我们没有发现较差的预后与 CRKP 分离或抗生素治疗不充分之间的关系。
