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Aslan AT, Kırbaş E, Sancak B, Tanrıverdi ES, Otlu B, Gürsoy NC, Yılmaz YA, Tozluyurt A, Liste Ü, Bıçakcıgil A, Hazırolan G, Dağ O, Güven GS. A retrospective observational cohort study of the clinical epidemiology of bloodstream infections due to carbapenem-resistant Klebsiella pneumoniae in an OXA-48 endemic setting. Int J Antimicrob Agents 2022; 59:106554. [PMID: 35176476 DOI: 10.1016/j.ijantimicag.2022.106554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/22/2022] [Accepted: 02/07/2022] [Indexed: 11/30/2022]
Abstract
We 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-center cohort study including all consecutive patients with CRKP BSIs treated between 01.01.2014 and 31.12.2018. Multivariate analysis, subgroup analysis and propensity score-matched analysis were employed to analyze 30-day mortality as the primary outcome. Clinical cure at day 14 was also analyzed in the whole cohort. 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 the onset of BSI (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 score-matched analyses and sensitivity analyses. Appropriate regimens were associated with better clinical outcomes than were inappropriate therapies in BSIs with CRKP possessing OXA-48, dominantly.
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Affiliation(s)
- Abdullah Tarık Aslan
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, 06100 Sihhiye, Ankara, Turkey
| | - Ekin Kırbaş
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, 06100 Sihhiye, Ankara, Turkey
| | - Banu Sancak
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, 06100 Sihhiye, Ankara, Turkey
| | - Elif Seren Tanrıverdi
- Inonu University Faculty of Medicine, Inonu University Turgut Ozal Medical Center, Department of Medical Microbiology, Molecular Microbiology Laboratory, 44000 Malatya, Turkey
| | - Barış Otlu
- Inonu University Faculty of Medicine, Inonu University Turgut Ozal Medical Center, Department of Medical Microbiology, Molecular Microbiology Laboratory, 44000 Malatya, Turkey
| | - Nafia Canan Gürsoy
- Inonu University Faculty of Medicine, Inonu University Turgut Ozal Medical Center, Department of Medical Microbiology, Molecular Microbiology Laboratory, 44000 Malatya, Turkey
| | - Yakut Akyön Yılmaz
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, 06100 Sihhiye, Ankara, Turkey
| | - Abdullah Tozluyurt
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, 06100 Sihhiye, Ankara, Turkey
| | - Ümran Liste
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, 06100 Sihhiye, Ankara, Turkey
| | - Asiye Bıçakcıgil
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, 06100 Sihhiye, Ankara, Turkey
| | - Gülşen Hazırolan
- Hacettepe University Faculty of Medicine, Department of Medical Microbiology, 06100 Sihhiye, Ankara, Turkey
| | - Osman Dağ
- Hacettepe University Faculty of Medicine, Department of Biostatistics, 06100 Sihhiye, Ankara, Turkey
| | - Gülay Sain Güven
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, 06100 Sihhiye, Ankara, Turkey
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- Hacettepe University Faculty of Medicine Department of Infectious Diseases and Clinical Microbiology, 06100 Sihhiye, Ankara, Turkey
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Büyükcam A, Bıçakcıgil A, Cengiz AB, Sancak B, Ceyhan M, Kara A. Stenotrophomonas maltophilia bacteremia in children - A 10-year analysis. ARCH ARGENT PEDIATR 2021; 118:e317-e323. [PMID: 32470274 DOI: 10.5546/aap.2020.eng.e317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 10/17/2019] [Indexed: 11/12/2022]
Abstract
Stenotrophomonas maltophilia is a multidrug-resistant, Gramnegative, and biofilm-forming pathogen. Information is limited concerning S. maltophilia bacteremia in children. Clinical data and microbiological test results collected in a tertiary children's hospital over a ten-year period were reviewed. Children 0-18 years old who had positive clinical specimen, blood and/or catheter cultures were included. We identified 20 S. maltophilia isolates from 12 pediatric patients with confirmed infections. The median age was 28 months (range: 3.1-187.3). The rate of previous use of antimicrobial therapy was 83 %. The median antibiotic number was 3 (range: 0-7) within 30 days prior to onset of S. maltophilia bacteremia. Catheter related infection was the main infectious source (66.6 %). The mortality rate was 33.3 %. The death of two non-survivors was associated with pneumonia. S. maltophilia should be considered a breakthrough agent for bacteremia in children with underlying disease exposed to broad-spectrum antibiotics during long-term hospitalization.
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Affiliation(s)
- Ayşe Büyükcam
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Asiye Bıçakcıgil
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ali B Cengiz
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Banu Sancak
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Ceyhan
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ateş Kara
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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