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

Introduction: 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 f...

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Autores:
Maraolo, Alberto Enrico
Corcione, Silvia
Grossi, Adriano
Signori, A.
Alicino, Cristiano
Hussein, Khetam
Trecarichi, Enrico Maria
Viale, Pierluigi
Timsit, Jéan-François
Veeraraghavan, Balaji
Villegas, María Virginia
Rahav, Galia
Daïkos, Georgios L.
Vardakas, Konstantinos Z.
Roilides, Emmanuel J.
Uhlemann, Anne Catrin
Ghafur, Abdul K.
Mornese Pinna, Simone
Bassetti, Matteo
Köhler, Philipp P.
Tipo de recurso:
Article of journal
Fecha de publicación:
2021
Institución:
Universidad El Bosque
Repositorio:
Repositorio U. El Bosque
Idioma:
eng
OAI Identifier:
oai:repositorio.unbosque.edu.co:20.500.12495/5564
Acceso en línea:
http://hdl.handle.net/20.500.12495/5564
https://doi.org/10.1007/s40121-021-00408-8
Palabra clave:
Active therapy
Individua lpatient data meta-analysis
Monotherapy
Carbapenem-resistant Klebsiella pneumoniae
Rights
openAccess
License
Atribución-NoComercial 4.0 Internacional
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dc.title.spa.fl_str_mv The Impact of carbapenem resistance on mortality in patients with klebsiella pneumoniae bloodstream infection: an individual patient data meta-analysis of 1952 patients
dc.title.translated.spa.fl_str_mv The Impact of carbapenem resistance on mortality in patients with klebsiella pneumoniae bloodstream infection: an individual patient data meta-analysis of 1952 patients
title The Impact of carbapenem resistance on mortality in patients with klebsiella pneumoniae bloodstream infection: an individual patient data meta-analysis of 1952 patients
spellingShingle The Impact of carbapenem resistance on mortality in patients with klebsiella pneumoniae bloodstream infection: an individual patient data meta-analysis of 1952 patients
Active therapy
Individua lpatient data meta-analysis
Monotherapy
Carbapenem-resistant Klebsiella pneumoniae
title_short The Impact of carbapenem resistance on mortality in patients with klebsiella pneumoniae bloodstream infection: an individual patient data meta-analysis of 1952 patients
title_full The Impact of carbapenem resistance on mortality in patients with klebsiella pneumoniae bloodstream infection: an individual patient data meta-analysis of 1952 patients
title_fullStr The Impact of carbapenem resistance on mortality in patients with klebsiella pneumoniae bloodstream infection: an individual patient data meta-analysis of 1952 patients
title_full_unstemmed The Impact of carbapenem resistance on mortality in patients with klebsiella pneumoniae bloodstream infection: an individual patient data meta-analysis of 1952 patients
title_sort The Impact of carbapenem resistance on mortality in patients with klebsiella pneumoniae bloodstream infection: an individual patient data meta-analysis of 1952 patients
dc.creator.fl_str_mv Maraolo, Alberto Enrico
Corcione, Silvia
Grossi, Adriano
Signori, A.
Alicino, Cristiano
Hussein, Khetam
Trecarichi, Enrico Maria
Viale, Pierluigi
Timsit, Jéan-François
Veeraraghavan, Balaji
Villegas, María Virginia
Rahav, Galia
Daïkos, Georgios L.
Vardakas, Konstantinos Z.
Roilides, Emmanuel J.
Uhlemann, Anne Catrin
Ghafur, Abdul K.
Mornese Pinna, Simone
Bassetti, Matteo
Köhler, Philipp P.
dc.contributor.author.none.fl_str_mv Maraolo, Alberto Enrico
Corcione, Silvia
Grossi, Adriano
Signori, A.
Alicino, Cristiano
Hussein, Khetam
Trecarichi, Enrico Maria
Viale, Pierluigi
Timsit, Jéan-François
Veeraraghavan, Balaji
Villegas, María Virginia
Rahav, Galia
Daïkos, Georgios L.
Vardakas, Konstantinos Z.
Roilides, Emmanuel J.
Uhlemann, Anne Catrin
Ghafur, Abdul K.
Mornese Pinna, Simone
Bassetti, Matteo
Köhler, Philipp P.
dc.contributor.orcid.none.fl_str_mv Villegas, María Virginia [0000-0003-1898-9067]
dc.subject.keywords.spa.fl_str_mv Active therapy
Individua lpatient data meta-analysis
Monotherapy
Carbapenem-resistant Klebsiella pneumoniae
topic Active therapy
Individua lpatient data meta-analysis
Monotherapy
Carbapenem-resistant Klebsiella pneumoniae
description Introduction: 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.
publishDate 2021
dc.date.accessioned.none.fl_str_mv 2021-03-08T15:21:00Z
dc.date.available.none.fl_str_mv 2021-03-08T15:21:00Z
dc.date.issued.none.fl_str_mv 2021-02-14
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dc.type.local.none.fl_str_mv Artículo de revista
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dc.identifier.issn.none.fl_str_mv 2193-6382
dc.identifier.uri.none.fl_str_mv http://hdl.handle.net/20.500.12495/5564
dc.identifier.doi.none.fl_str_mv https://doi.org/10.1007/s40121-021-00408-8
dc.identifier.instname.spa.fl_str_mv instname:Universidad El Bosque
dc.identifier.reponame.spa.fl_str_mv reponame:Repositorio Institucional Universidad El Bosque
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identifier_str_mv 2193-6382
instname:Universidad El Bosque
reponame:Repositorio Institucional Universidad El Bosque
repourl:https://repositorio.unbosque.edu.co
url http://hdl.handle.net/20.500.12495/5564
https://doi.org/10.1007/s40121-021-00408-8
dc.language.iso.none.fl_str_mv eng
language eng
dc.relation.ispartofseries.spa.fl_str_mv Infectious diseases and therapy, 2193-6382, 2021
dc.relation.uri.none.fl_str_mv https://link.springer.com/article/10.1007%2Fs40121-021-00408-8
dc.rights.*.fl_str_mv Atribución-NoComercial 4.0 Internacional
dc.rights.uri.*.fl_str_mv http://creativecommons.org/licenses/by-nc/4.0/
dc.rights.local.spa.fl_str_mv Acceso abierto
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eu_rights_str_mv openAccess
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dc.publisher.spa.fl_str_mv Springer Nature
dc.publisher.journal.spa.fl_str_mv Infectious diseases and therapy
institution Universidad El Bosque
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spelling Maraolo, Alberto EnricoCorcione, SilviaGrossi, AdrianoSignori, A.Alicino, CristianoHussein, KhetamTrecarichi, Enrico MariaViale, PierluigiTimsit, Jéan-FrançoisVeeraraghavan, BalajiVillegas, María VirginiaRahav, GaliaDaïkos, Georgios L.Vardakas, Konstantinos Z.Roilides, Emmanuel J.Uhlemann, Anne CatrinGhafur, Abdul K.Mornese Pinna, SimoneBassetti, MatteoKöhler, Philipp P.Villegas, María Virginia [0000-0003-1898-9067]2021-03-08T15:21:00Z2021-03-08T15:21:00Z2021-02-142193-6382http://hdl.handle.net/20.500.12495/5564https://doi.org/10.1007/s40121-021-00408-8instname:Universidad El Bosquereponame:Repositorio Institucional Universidad El Bosquerepourl:https://repositorio.unbosque.edu.coapplication/pdfengSpringer NatureInfectious diseases and therapyInfectious diseases and therapy, 2193-6382, 2021https://link.springer.com/article/10.1007%2Fs40121-021-00408-8Atribución-NoComercial 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc/4.0/Acceso abiertohttp://purl.org/coar/access_right/c_abf2info:eu-repo/semantics/openAccessAcceso abiertoThe Impact of carbapenem resistance on mortality in patients with klebsiella pneumoniae bloodstream infection: an individual patient data meta-analysis of 1952 patientsThe Impact of carbapenem resistance on mortality in patients with klebsiella pneumoniae bloodstream infection: an individual patient data meta-analysis of 1952 patientsArtículo de revistahttp://purl.org/coar/resource_type/c_6501http://purl.org/coar/resource_type/c_2df8fbb1info:eu-repo/semantics/articlehttp://purl.org/coar/version/c_970fb48d4fbd8a85Active therapyIndividua lpatient data meta-analysisMonotherapyCarbapenem-resistant Klebsiella pneumoniaeIntroduction: 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.LICENSElicense.txtlicense.txttext/plain; charset=utf-81748https://repositorio.unbosque.edu.co/bitstreams/7a492b00-b3e9-4367-9f94-f2e32eca4296/download8a4605be74aa9ea9d79846c1fba20a33MD53ORIGINALAlberto E. Maraolo.Silvia Corcione.Adriano Grossi.Alessio Signori_2021.pdfAlberto E. 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