Prognosis of urinary tract infection caused by KPC-producing Klebsiella pneumoniae: The impact of inappropriate empirical treatment - 31/07/19
, Julian Torre-Cisneros d, †Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain
Highlights |
• | Patients with urinary tract infection due to carbapenemase-producing Klebsiella pneumoniae, experienced higher clinical failure than patients with carbapenem-susceptible strains. |
• | It is associated with the high rate of inappropriate empirical treatment. |
• | Carbapenemase-producing Klebsiella pneumoniae aetiology in urinary tract infection is not independently associated with all-cause mortality. |
• | The profiles of hospitalized patients with urinary tract infection of both cohorts are very similar. Previous antibiotics use and colonisation may help to identify carbapenemase-producing aetiology. |
Summary |
Introduction |
There is scarce information on the prognosis of urinary tract infections (UTI) caused by KPC carbapenemase-producing Klebsiella pneumoniae (KPC-Kp).
Objetive |
To investigate the association between KPC-Kp aetiology and clinical failure and all cause mortality and to explore the impact of inappropriate empirical treatment.
Material and methods |
This is a retrospective observational study of hospitalized patients with UTI due to K. pneumoniae. We explored clinical failure at day 21 and 30-day all-cause mortality using different models of adjusted analysis.
Results |
We analyzed 142 episodes of UTI; 46 episodes (32.4%) were due to KPC-Kp and 96 episodes (67.6%) were due to non-KPC-Kp strains (62 wild type and 34 EBSL producer). Clinical failure was more frequent in the KPC-Kp group (41.3% vs. 15.6%, p = 0.001). KPC-Kp aetiology and inappropriate empirical therapy were associated in the non-adjusted analysis with clinical failure. When analysed in separate adjusted models, both were found to be associated; inappropriate empirical treatment (OR 2.51; 95% CI, 1.03–6.12; p = 0.04) and KPC-Kp (OR 2.73; 95% CI, 1.03–7.22; p = 0.04) were associated with increased risk of failure. All-cause 30-day mortality was higher in patients with KPC-Kp UTI (39.1% vs. 15.6%, p = 0.002). Bacteraemia was more frequent in patients with KPC-Kp etiology (23.9% vs. 10.4%; p = 0.034). In both cases, the association was not confirmed in the adjusted analysis.
Conclusion |
KPC-Kp UTI is associated with higher clinical failure and may be due to an increase in inappropriate empirical treatment.
Le texte complet de cet article est disponible en PDF.Keywords : Klebsiella pneumoniae, Carbapenemase, Urinary tract infection, Prognosis, Treatment
Plan
Vol 79 - N° 3
P. 245-252 - septembre 2019 Retour au numéro
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