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Carbapenemase-producing Klebsiella pneumoniae bloodstream infections in neutropenic patients with haematological malignancies or aplastic anaemia: Analysis of 50 cases

2016; Elsevier BV; Volume: 47; Issue: 4 Linguagem: Inglês

10.1016/j.ijantimicag.2016.01.011

1872-7913

Polydoros Tofas, Anna Skiada, Maria K. Angelopoulou, Nikolaos V. Sipsas, Ioanna D. Pavlopoulou, Sofia Tsaousi, Maria Pagoni, Maria Kotsopoulou, Stavroula Perlorentzou, Anastasia Antoniadou, Maria Pirounaki, Athanasios Skoutelis, George L. Daikos,

Bacterial Identification and Susceptibility Testing

Carbapenemase-producing Klebsiella pneumoniae (CP-Kp) are currently among the most important nosocomial pathogens in many geographic regions. A retrospective study was conducted between 2010 and 2014 in four hospitals located in a high-prevalence area (Athens, Greece) to describe the clinical features, treatment and outcomes of neutropenic patients with haematological diseases complicated with CP-Kp bloodstream infections. A total of 50 patients were identified, including 48 with haematological malignancies and 2 with aplastic anaemia. All patients had neutropenia (<500 cells/mm(3)), of whom 40 had <100 neutrophils/mm(3). The probable source of bacteraemia was identified in 9 patients; in the remaining 41 patients the bacteraemia was considered primary. For definitive treatment, 30 patients received combination therapy (two or more active drugs), 10 received monotherapy (one active drug) and 4 received therapy with no active drug; the remaining 6 patients died within 48 h after the onset of bacteraemia. The 14-day all-cause mortality rate was 50%, 38% and 33% for those who received one, two or three active drugs respectively. In the Cox proportional hazards model, unresolved neutropenia [hazard ratio (HR)=19.28, 95% confidence interval (CI) 2.31-160.69; P=0.006], septic shock (HR=3.04, 95% CI 1.06-8.78; P=0.04) and treatment with one active drug (HR for monotherapy versus combination therapy=3.95, 95% CI 1.23-12.65; P=0.02) were independent predictors of death, whilst combination therapy was associated with lower mortality. These findings may assist physicians in making treatment decisions for neutropenic patients with CP-Kp infections.