Mortality attributable to different Klebsiella susceptibility patterns and to the coverage of empirical antibiotic thera
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ORIGINAL
Mortality attributable to different Klebsiella susceptibility patterns and to the coverage of empirical antibiotic therapy: a cohort study on patients admitted to the ICU with infection GiViTI Steering Committee, Guido Bertolini1, Giovanni Nattino1, Carlo Tascini2, Daniele Poole3, Bruno Viaggi4, Greta Carrara1* , Carlotta Rossi1, Daniele Crespi1, Matteo Mondini1, Martin Langer5, Gian Maria Rossolini6,7 and Paolo Malacarne8 © 2018 Springer-Verlag GmbH Germany, part of Springer Nature and ESICM
Abstract Purpose: To evaluate the prognostic importance of different Klebsiella spp. sensitivity patterns: multi-susceptible Klebsiella (MS-K), extended-spectrum cephalosporin-resistant, but carbapenem-susceptible Klebsiella (ESCR-CS-K), and carbapenem-resistant Klebsiella (CR-K). Methods: We developed a prognostic model to predict hospital mortality in patients with infection on admission to the intensive care units (ICUs), and assessed its calibration in the subgroups of interest: patients with infections due to MS-K, ESCR-CS-K, CR-K. We assessed the calibration of the model also in ESCR-CS-K treated empirically with carbapenems and with piperacillin-tazobactam. Results: A total of 13,292 adults with an ongoing infection were admitted to 137 Italian ICUs in 2012–2013. Of 801 Klebsiella spp. infected patients, 451 had MS-K, 116 ESCR-CS-K, and 234 CR-K. The prognostic model calibrated well for the MS-K and ESCR-CS-K subgroups. In the CR-K subgroup there were more deaths than predicted (standardized mortality ratio 1.20; 95% CI 1.08–1.31), indicating a negative prognostic role of the infection, mainly in the medium and high risk-of-death patients. When infection was caused by ESCR-CS-K, treatment with piperacillin-tazobactam increased adjusted mortality among the most severe patients (similarly to CR-K), while treatment with carbapenems did not (similarly to MS-K). Conclusions: In low risk-of-death patients admitted to the ICU with a Klebsiella spp. infection, the appropriateness of empirical antibiotic therapy seemed uninfluential to eventual mortality, while it appeared to be crucial in high-risk ones. The use of piperacillin-tazobactam may be inappropriate in severe patients with ESCR-CS-K infection. CR-K is associated to a significant 20% increase of adjusted mortality, only for patients at higher risk of death. Keywords: Klebsiella infections, Attributable mortality, Intensive care units, Drug resistance, Multicenter study *Correspondence: [email protected] 1 GiViTI Coordinating Center, Centro di Ricerche Cliniche per le Malattie Rare Aldo e Cele Daccò, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 24020 Bergamo, Ranica, Italy Full author information is available at the end of the article The members of the GiViTI Steering Committee are listed in the Acknowledgements.
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Introduction Enterobacteriaceae are among the most common causes of bacterial infections in hospital patients, and the spread of multi-drug resistant (MDR) strains has become a global emergency [1]. The problem, init
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