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Title

Impact of KPC Production and High-Level Meropenem Resistance on All-Cause Mortality of Ventilator-Associated Pneumonia in Association with Klebsiella pneumoniae

AuthorsRivera-Espinar, Francisco; Machuca, Isabel; Tejero, Rocío; Rodríguez, Jorge; Mula, Ana; Marfil-Pérez, Eduardo; Cano, Ángela; Gutiérrez-Gutiérrez, Belén; Rodríguez, Marina; Pozo, Juan Carlos; Fuente, Carmen de la; Rodríguez-Baño, Jesús; Martínez-Martínez, Luis; León, Rafael ; Torre-Cisneros, Julián
KeywordsKPC
Klebsiella pneumoniae
Ventilator-associated pneumonia
Mortality
Issue Date21-May-2020
PublisherAmerican Society for Microbiology
CitationAntimicrobial Agents and Chemotherapy 64: e02164-19 (2020)
AbstractCarbapenemase-producing Enterobacterales and specifically Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KPC-Kp) are rapidly spreading worldwide. The prognosis of ventilator-associated pneumonia (VAP) caused by KPC-Kp is not well known. Our study tries to assess whether ventilator-associated pneumonia caused by a KPC-Kp strain is associated with higher all-cause mortality than that caused by carbapenem-susceptible isolates. This is a retrospective cohort study of patients with VAP due to K. pneumoniae from a 35-bed polyvalent intensive care unit in a university hospital (>40,000 annual admissions) between January 2012 and December 2016. Adjusted multivariate analysis was used to study the association of KPC-Kp with 30-day all-cause mortality (Cox regression). We analyze 69 cases of K. pneumoniae VAP, of which 39 were produced by a KPC-Kp strain with high-level resistance to meropenem (MIC > 16 mg/ml). All-cause mortality at 30 days was 41% in the KPC-Kp group (16/39) and 33.3% in the carbapenem-susceptible cases (10/30). KPC-Kp etiology was not associated with higher mortality when controlled for confounders (adjusted hazard ratio [HR], 1.25; 95% confidence interval [CI], 0.46 to 3.41). Adequate targeted therapy (HR, 0.03; 95% CI, <0.01 to 0.23) was associated with all-cause mortality. Assuming the limitations due to the available sample size, the prognosis of VAP caused by KPC-Kp is similar to VAPs caused by carbapenem-susceptible K. pneumoniae when appropriate treatment is used.
Publisher version (URL)http://doi.org/10.1128/AAC.02164-19
URIhttp://hdl.handle.net/10261/230130
Identifiersdoi: 10.1128/AAC.02164-19
issn: 0066-4804
e-issn: 1098-6596
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