The Impact of carbapenem resistance on mortality in patients with klebsiella pneumoniae bloodstream infection: an individual patient data meta-analysis of 1952 patients

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dc.contributor.authorMaraolo, Alberto Enrico
dc.contributor.authorCorcione, Silvia
dc.contributor.authorGrossi, Adriano
dc.contributor.authorSignori, A.
dc.contributor.authorAlicino, Cristiano
dc.contributor.authorHussein, Khetam
dc.contributor.authorTrecarichi, Enrico Maria
dc.contributor.authorViale, Pierluigi
dc.contributor.authorTimsit, Jéan-François
dc.contributor.authorVeeraraghavan, Balaji
dc.contributor.authorVillegas, María Virginia
dc.contributor.authorRahav, Galia
dc.contributor.authorDaïkos, Georgios L.
dc.contributor.authorVardakas, Konstantinos Z.
dc.contributor.authorRoilides, Emmanuel J.
dc.contributor.authorUhlemann, Anne Catrin
dc.contributor.authorGhafur, Abdul K.
dc.contributor.authorMornese Pinna, Simone
dc.contributor.authorBassetti, Matteo
dc.contributor.authorKöhler, Philipp P.
dc.contributor.orcidVillegas, María Virginia [0000-0003-1898-9067]
dc.date.accessioned2021-03-08T15:21:00Z
dc.date.available2021-03-08T15:21:00Z
dc.date.issued2021-02-14
dc.description.abstractenglishIntroduction: Available evidence from observational studies and meta-analyses has highlighted an increased mortality in patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections (BSI) compared with their carbapenem-susceptible (CSKP) counterparts, but the exact reasons for this outcome difference are still to be determined. Methods: We updated the search of a previous meta-analysis through four databases up to April 2018. A two-stage individual-patient data (IPD) meta-analysis was conducted, building an adjusting model to account for age, comorbidities and activity of empirical and targeted antimicrobial therapy. The protocol was registered on PROSPERO (identifier: CRD42018104256). Results: IPD data were obtained from 14 out of 28 eligible observational studies. A total of 1952 patients were investigated: 1093 in the CRKP group and 859 in the CSKP group. Patients with CRKP-BSI had a twofold risk of death compared with CSKP-infected patients [adjusted odds ratio (aOR) 2.17; 95% confidence interval (CI) 1.56–3.04; I2 = 44.1%]. Mortality was higher in patients with CRKP BSI, in both the subgroup of absent/inactive (aOR 1.75; 95% CI 1.24–2.47; I2 = 0) and of active initial therapy (aOR 2.66; 95% CI 1.70–4.16; I2 = 16%) as well as in case of active targeted therapy (aOR 2.21; 95% CI 1.36–3.59; I2 = 58%). Conclusion: Resistance to carbapenem is associated with worse outcome in patients with BSI by Klebsiella pneumoniae even adjusting for comorbidities and treatment appropriateness according to in vitro activity of empirical and targeted therapy. This applies to a scenario dominated by colistin-based therapies for CRKP. Further studies are needed to compare the mortality difference between CRKP and CSKP cases in the light of new anti-CRKP antimicrobials.eng
dc.format.mimetypeapplication/pdf
dc.identifier.doihttps://doi.org/10.1007/s40121-021-00408-8
dc.identifier.instnameinstname:Universidad El Bosquespa
dc.identifier.issn2193-6382
dc.identifier.reponamereponame:Repositorio Institucional Universidad El Bosquespa
dc.identifier.repourlrepourl:https://repositorio.unbosque.edu.co
dc.identifier.urihttps://hdl.handle.net/20.500.12495/5564
dc.language.isoeng
dc.publisherSpringer Naturespa
dc.publisher.journalInfectious diseases and therapyspa
dc.relation.ispartofseriesInfectious diseases and therapy, 2193-6382, 2021spa
dc.relation.urihttps://link.springer.com/article/10.1007%2Fs40121-021-00408-8
dc.rightsAtribución-NoComercial 4.0 Internacional*
dc.rights.accessrightshttps://purl.org/coar/access_right/c_abf2
dc.rights.accessrightsinfo:eu-repo/semantics/openAccess
dc.rights.accessrightsAcceso abierto
dc.rights.localAcceso abiertospa
dc.rights.urihttps://creativecommons.org/licenses/by-nc/4.0/*
dc.subject.keywordsActive therapyspa
dc.subject.keywordsIndividua lpatient data meta-analysisspa
dc.subject.keywordsMonotherapyspa
dc.subject.keywordsCarbapenem-resistant Klebsiella pneumoniaespa
dc.titleThe Impact of carbapenem resistance on mortality in patients with klebsiella pneumoniae bloodstream infection: an individual patient data meta-analysis of 1952 patientsspa
dc.title.translatedThe Impact of carbapenem resistance on mortality in patients with klebsiella pneumoniae bloodstream infection: an individual patient data meta-analysis of 1952 patientsspa
dc.type.coarhttps://purl.org/coar/resource_type/c_6501
dc.type.driverinfo:eu-repo/semantics/article
dc.type.hasversioninfo:eu-repo/semantics/publishedVersion
dc.type.localArtículo de revista

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