Infection with Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae in cancer patients

• Published in: European journal of clinical microbiology & infectious diseases Vol. 34; no. 2; pp. 277 - 286
• Main Authors: Freire, M. P., Pierrotti, L. C., Filho, H. H. C., Ibrahim, K. Y., Magri, A. S. G. K., Bonazzi, P. R., Hajar, L., Diz, M. P. E., Pereira, J., Hoff, P. M., Abdala, E.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-02-2015; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial agents; Automation; Bacteremia; Bacterial Proteins - metabolism; beta-Lactamases - metabolism; Biomedical and Life Sciences; Biomedicine; Cancer; Cross Infection; Female; Health risks; Hospitals; Humans; Infections; Infectious diseases; Intensive care; Internal Medicine; Klebsiella Infections - complications; Klebsiella Infections - microbiology; Klebsiella Infections - mortality; Klebsiella pneumoniae; Klebsiella pneumoniae - enzymology; Laboratories; Male; Medical Microbiology; Middle Aged; Molecular biology; Mortality; Mortality risk; Neoplasms - complications; Neoplasms - microbiology; Neoplasms - mortality; Polymerase chain reaction; Risk Factors; Transplants & implants; Brazil; United States > US; Carbapenem; Colistin; Polymyxin; Sequential Organ Failure Assessment Score; Sequential Organ Failure Assessment
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-014-2233-5

Klebsiella pneumoniae
carbapenemase (KPC)-producing
K. pneumoniae
(KPC-Kp) is an emergent pathogen in healthcare-associated infections (HAIs). The aim of this study was to describe HAIs due to KPC-Kp, as well as identify mortality risk factors in cancer patients. In patients diagnosed with HAIs due to KPC-Kp between January 2009 and July 2013, we evaluated only the first infection episode of each patient, analyzing mortality separately for patients treated for ≥48 h with at least one antimicrobial agent proven to display in vitro activity against KPC-Kp. We evaluated variables related to the malignancy, the severity and characteristics of the HAI, and the antimicrobial therapy. We identified 83 HAIs due to KPC-Kp. The 30-day mortality was 57.8 % for all infections and 72.7 % for bacteremic infections. Of the 83 patients, 60 patients received ≥48 h of appropriate treatment and 44 (53 %) developed bacteremia. Ten patients (12 %) were neutropenic at HAI diagnosis and 33 (39.8 %) had infection at the tumor site. The most common HAI was urinary tract infection, seen in 26 patients (31.3 %), followed by primary bloodstream infection, seen in 24 patients (28.9 %). Forty-four patients (73.3 %) received combination antimicrobial therapy, most often including polymyxin (68.3 %). Risk factors for 30-day mortality are high sequential organ failure assessment (SOFA) score, need for intensive care stay at diagnosis of infection, and acute kidney injury; the removal of invasive devices related to infection and treatment with effective antibiotics for KPC-Kp are protective factors. In cancer patients, high mortality is associated with HAI due to KPC-Kp and mortality risk factors are more often related to acute infection than to the underlying disease.