Authors: M P Freire L C Pierrotti H H C Filho K Y Ibrahim A S G K Magri P R Bonazzi L Hajar M P E Diz J Pereira P M Hoff E Abdala
Publish Date: 2014/08/30
Volume: 34, Issue: 2, Pages: 277-286
Abstract
Klebsiella pneumoniae carbapenemase KPCproducing K pneumoniae KPCKp is an emergent pathogen in healthcareassociated infections HAIs The aim of this study was to describe HAIs due to KPCKp as well as identify mortality risk factors in cancer patients In patients diagnosed with HAIs due to KPCKp between January 2009 and July 2013 we evaluated only the first infection episode of each patient analyzing mortality separately for patients treated for ≥48 h with at least one antimicrobial agent proven to display in vitro activity against KPCKp We evaluated variables related to the malignancy the severity and characteristics of the HAI and the antimicrobial therapy We identified 83 HAIs due to KPCKp The 30day mortality was 578 for all infections and 727 for bacteremic infections Of the 83 patients 60 patients received ≥48 h of appropriate treatment and 44 53 developed bacteremia Ten patients 12 were neutropenic at HAI diagnosis and 33 398 had infection at the tumor site The most common HAI was urinary tract infection seen in 26 patients 313 followed by primary bloodstream infection seen in 24 patients 289 Fortyfour patients 733 received combination antimicrobial therapy most often including polymyxin 683 Risk factors for 30day mortality are high sequential organ failure assessment SOFA score need for intensive care stay at diagnosis of infection and acute kidney injury the removal of invasive devices related to infection and treatment with effective antibiotics for KPCKp are protective factors In cancer patients high mortality is associated with HAI due to KPCKp and mortality risk factors are more often related to acute infection than to the underlying disease
Keywords: