A retrospective observational cohort study of the clinical epidemiology of bloodstream infections due to carbapenem-resistant Klebsiella pneumoniae in an OXA-48 endemic setting

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dc.authoridTanriverdi, Elif Seren/0000-0002-0449-0356
dc.authoridBilir, Yeliz/0000-0003-2217-4741
dc.authoridAKYON YILMAZ, YAKUT/0000-0002-0919-5508
dc.authoridOtlu, Baris/0000-0002-6220-0521
dc.authoridTozluyurt, Abdullah/0000-0001-7036-0587
dc.authorwosidKırbaş, Ekin/KFA-9949-2024
dc.authorwosidDag, Osman/S-5379-2016
dc.authorwosidTanriverdi, Elif Seren/ABE-4472-2021
dc.authorwosidAslan, Abdullah Tarık/AAP-8774-2021
dc.authorwosidBilir, Yeliz/GPG-1602-2022
dc.authorwosidAKYON YILMAZ, YAKUT/HJI-0282-2023
dc.contributor.authorAslan, Abdullah Tarik
dc.contributor.authorKirbas, Ekin
dc.contributor.authorSancak, Banu
dc.contributor.authorTanriverdi, Elif Seren
dc.contributor.authorOtlu, Baris
dc.contributor.authorGursoy, Nafia Canan
dc.contributor.authorYilmaz, Yakut Akyon
dc.date.accessioned2024-08-04T20:51:49Z
dc.date.available2024-08-04T20:51:49Z
dc.date.issued2022
dc.departmentİnönü Üniversitesien_US
dc.description.abstractThis study aimed to characterize the epidemiology and clinical outcomes of patients with bloodstream infections (BSIs) due to carbapenem-resistant Klebsiella pneumoniae (CRKP) in an OXA-48-predominant environment. This was a retrospective single-centre cohort study including all consecutive patients with CRKP BSIs treated between 1 January 2014 and 31 December 2018. Multivariate analysis, subgroup analysis and propensity-score-matched analysis were employed to analyse 30-day mortality as the primary outcome. Clinical cure at day 14 was also analysed for the whole cohort. In total, 124 patients with unique isolates met all the inclusion criteria. OXA-48 was the most common type of carbapenemase (85.5%). Inappropriate therapy was significantly associated with 30-day mortality [70.6% vs 39.7%, adjusted odds ratio (aOR) 4.65, 95% confidence interval (CI) 1.50-14.40, P=0.008] and 14-day clinical failure (78.5% vs 56.2%, aOR 3.14, 95% CI 1.09-9.02, P=0.033) in multivariate analyses. Among those treated appropriately, the 30-day mortality rates were similar in monotherapy and combination therapy arms (OR 2.85, 95% CI 0.68-11.95, P=0.15). INCREMENT CPE mortality score (aOR 1.16, 95% CI 1.01-1.33, P=0.029), sepsis at BSI onset (aOR 2.90, 95% CI 1.02-8.27, P=0.046), and inappropriate therapy (aOR 4.65, 95% CI 1.50-14.40, P= 0.008) were identified as independent risk factors for 30-day mortality. Colistin resistance in CRKP had no significant impact on 30-day mortality. These results were also confirmed in all propensity-scorematched analyses and sensitivity analyses. Appropriate regimens were associated with better clinical outcomes than inappropriate therapies for BSIs with CRKP predominantly possessing OXA-48. (c) 2022 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.en_US
dc.description.sponsorshipHacettepe University Scientific Research Council [THD-18711]; Pfizer [PF-06416494, WI247317]en_US
dc.description.sponsorshipThis study was supported by Hacettepe University Scientific Research Council (Grant No. THD-18711). Furthermore, Pfizer provided 1 g avibactam-sodium powder (PF-06416494) as a compound transfer agreement grant (Grant No. WI247317). Hacettepe University Scientific Research Council and Pfizer had no role in the design and execution of the study, collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; nor the decision to submit the manuscript for publication, veto publication, or to control the journal to which this paper was submitted.en_US
dc.identifier.doi10.1016/j.ijantimicag.2022.106554
dc.identifier.issn0924-8579
dc.identifier.issn1872-7913
dc.identifier.issue4en_US
dc.identifier.pmid35176476en_US
dc.identifier.scopus2-s2.0-85127366976en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.urihttps://doi.org/10.1016/j.ijantimicag.2022.106554
dc.identifier.urihttps://hdl.handle.net/11616/100578
dc.identifier.volume59en_US
dc.identifier.wosWOS:000821489800006en_US
dc.identifier.wosqualityQ1en_US
dc.indekslendigikaynakWeb of Scienceen_US
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakPubMeden_US
dc.language.isoenen_US
dc.publisherElsevieren_US
dc.relation.ispartofInternational Journal of Antimicrobial Agentsen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/closedAccessen_US
dc.subjectCarbapenem-resistant Klebsiella pneumoniaeen_US
dc.subjectMortalityen_US
dc.subjectOXA-48-likeen_US
dc.subjectTreatmenten_US
dc.subjectCarbapenemaseen_US
dc.titleA retrospective observational cohort study of the clinical epidemiology of bloodstream infections due to carbapenem-resistant Klebsiella pneumoniae in an OXA-48 endemic settingen_US
dc.typeArticleen_US

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