Internal Medicine Unit, Felice Lotti Hospital of Pontedera, Azienda Unità Sanitaria Locale Toscana Nord-Ovest, Pisa, Italy.
Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
Intern Emerg Med. 2023 Nov;18(8):2261-2269. doi: 10.1007/s11739-023-03416-3. Epub 2023 Sep 12.
Real-life outcomes data for elderly patients with infections caused by Klebsiella pneumoniae producing New Delhi metallo-beta-lactamase (NDM-Kp) are lacking. We conducted a retrospective cohort study enrolling 33 consecutive adult patients (mean age 77.4 years; 48.5% males; mean Charlson Comorbidity Index-CCI 5.9) hospitalized for NDM-Kp infections during a 24-month period in an Italian highly endemic area. 78.8% were admitted to Internal Medicine ward. 45.4% of patients had bloodstream infections (BSI), 39.4% urinary tract infections (UTI) without BSI, 9.1% respiratory tract infections and 6.1% intra-abdominal infections. 93.9% had rectal colonization.Adequate definitive antibiotic therapy (mainly represented by aztreonam plus ceftazidime/avibactam) was provided to 36.4% of cases. Mean age and CCI of patients adequately treated were significantly lower than those inadequately treated (71.2 vs 80.9 years, p = 0.041, and 4.6 vs 6.7, p = 0.040, respectively). Patients adequately treated had a mean hospitalization length significantly higher (28 vs 15 days, p = 0.016). The overall 30-day survival rate of patients adequately and inadequately treated was 83.3% and 57.1%, respectively: this difference was not statistically significant. Mean age and CCI of 22 patients who survived at 30 days were lower than those of 11 patients who died (73.7 vs 84.8 years, p = 0.003, and 5.3 vs 7.2, p = 0.049, respectively). Twelve survivors received an inadequate therapy: 8/12 had UTI. Six of nine patients inadequately treated who died within 30 days, died before microbiological diagnosis. Our study provides real-life data on outcomes of elderly and multimorbid patients hospitalized for infections caused by NDM-Kp. Further studies with larger sample size are warranted.
有关产新德里金属β-内酰胺酶（NDM-Kp）肺炎克雷伯菌所致老年感染患者的真实临床结局数据尚缺乏。我们进行了一项回顾性队列研究，纳入了意大利高度流行地区 24 个月期间因 NDM-Kp 感染住院的 33 例连续成年患者（平均年龄 77.4 岁；48.5%为男性；平均 Charlson 合并症指数-CCI 5.9）。78.8%患者入内科学病房。45.4%的患者发生血流感染（BSI），39.4%为无 BSI 的尿路感染（UTI），9.1%为呼吸道感染，6.1%为腹腔内感染。93.9%患者直肠带菌。36.4%的患者接受了适当的明确抗生素治疗（主要为氨曲南联合头孢他啶/阿维巴坦）。适当治疗和不适当治疗的患者的平均年龄和 CCI 差异有统计学意义（71.2 岁比 80.9 岁，p=0.041，4.6 比 6.7，p=0.040）。适当治疗的患者平均住院时间明显更长（28 天比 15 天，p=0.016）。适当和不适当治疗的患者的 30 天总体生存率分别为 83.3%和 57.1%：差异无统计学意义。22 例存活至 30 天的患者的平均年龄和 CCI 低于 11 例死亡患者（73.7 岁比 84.8 岁，p=0.003，5.3 比 7.2，p=0.049）。12 例存活患者接受了不适当的治疗：8/12 例为 UTI。9 例 30 天内死亡且未进行微生物学诊断的患者中，6 例接受了不适当的治疗。我们的研究提供了关于 NDM-Kp 感染住院老年和多合并症患者结局的真实数据。需要更大样本量的进一步研究。
