Epidemiology of Carbapenemase-Producing Klebsiella pneumoniae in a Portuguese Tertiary Hospital

Background

Carbapenemase-producing Klebsiella pneumoniae (CPKp) are considered a public health problem. To manage this multidrug-resistant organism (MDRO), it is important to identify individuals at higher risk. We describe risk factors for CPKp among a population who acquired this MDRO, in a tertiary hospital Center (THC), from 2017 to 2019.

Methods

Descriptive study, with data from medical record, in a 1100 bed THC, with active surveillance (high risk population at admission and CPKp direct contacts). Participants: patients > =18 years old, with length of stay (LOS) >48 hours, in which CPKp was identified in clinical samples > =48 h after admission and without previous history of this MDRO.

Results

Incidence rate increased from 0.031 (2017) to 0.090 (2018) cases per 1000 patient-days and was 0.081 in 2019 (p = 0.004). Evolution of CPKp proportion was 1.6%, 3.9% and 4.1%, respectively. In 2019, 12 patients (40.0%) were at intensive care when this MDRO was detected. During these 3 years, CPKp was more frequently identified in urine (31.3 - 54.5%) and respiratory products (13.3 - 36.4%). The median LOS until CPKp isolation was 10.0 to 24.0 days and, until discharge, 15.0 to 25.5 days. Fatal outcome occurred in 8 (25.0%) and 7 (23.3%) patients in 2018 and 2019, respectively. Most cases were exposed to antibiotics (81.8 - 90.6%), had a urinary catheter (63.6 - 75.0%) and were dependent for hygiene activities (63.6 - 66.7%). Many had a central line (21.9 - 43.3%), previous surgery (45.5 - 63.3%) and hospital admission in the previous 6 months (27.3 - 40.6%). Along these 3 years, none of these variations was statistically significant.

Conclusions

In this THC, CPKp increased from 2017 to 2018 and remained stable afterwards. It affected mostly male patients, exposed to antibiotics, with urinary catheter and dependent in their hygiene activities. In order to have an adequate CPKp containment strategy it is essential to know the population who acquired this MDRO.

Key messages

CPKp increased from 2017 to 2018 and remained stable afterwards, affecting mostly male patients, exposed to antibiotics, with urinary catheter and dependent in their hygiene activities. In order to have an adequate CPKp containment strategy it is essential to know the population who acquired this MDRO during their stay.

PLX-PAD Cell Treatment of Critical Limb Ischaemia: Rationale and Design of the PACE Trial

BACKGROUND

Critical limb ischaemia (CLI) is a life threatening condition with a considerable risk of major amputation and death. Besides revascularisation, no treatment has been proven to reduce the risks. Therapeutic angiogenesis by gene or cell therapy has not demonstrated definitive evidence in randomised controlled trials. PLX-PAD is an "off the shelf" allogeneic placental derived, mesenchymal like cell therapy, which, in preclinical studies, has shown pro-angiogenic, anti-inflammatory, and regenerative properties. Favourable one year amputation free survival (AFS), and trends in reduction of pain scores and increase of tissue perfusion have been shown in two small, open label, phase I trials.

METHODS

The PACE study is a phase III randomised, double blind, multicentre, multinational placebo controlled, parallel group study to evaluate the efficacy, tolerability, and safety of intramuscular injections of PLX-PAD cells to treat patients with atherosclerotic CLI with minor tissue loss (Rutherford Category 5) up to the ankle level, who are unsuitable for revascularisation or carry an unfavourable risk benefit for that treatment. The study will enroll 246 patients, who after screening are randomised in a ratio of 2:1 to treatment with intramuscular injections of PLX-PAD 300 × 10⁶ cells or placebo on two occasions, eight weeks apart. The primary efficacy endpoint is time to major amputation or death (amputation free survival), which will be assessed in follow up of at least 12 months and up to 36 months.

CONCLUSIONS

Based on favourable pre-clinical and initial clinical study results, the PACE phase III randomised controlled trial will evaluate placenta derived PLX-PAD cell treatment in patients with critical limb ischaemia, with an unfavourable risk benefit for revascularisation. Clinicaltrials.gov: NCT03006770.