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...
- 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
- 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 |
dc.type.coar.fl_str_mv |
http://purl.org/coar/resource_type/c_2df8fbb1 |
dc.type.coarversion.fl_str_mv |
http://purl.org/coar/version/c_970fb48d4fbd8a85 |
dc.type.local.none.fl_str_mv |
Artículo de revista |
dc.type.coar.none.fl_str_mv |
http://purl.org/coar/resource_type/c_6501 |
dc.type.driver.none.fl_str_mv |
info:eu-repo/semantics/article |
format |
http://purl.org/coar/resource_type/c_6501 |
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 |
dc.identifier.repourl.none.fl_str_mv |
repourl:https://repositorio.unbosque.edu.co |
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 |
dc.rights.accessrights.none.fl_str_mv |
http://purl.org/coar/access_right/c_abf2 info:eu-repo/semantics/openAccess Acceso abierto |
rights_invalid_str_mv |
Atribución-NoComercial 4.0 Internacional http://creativecommons.org/licenses/by-nc/4.0/ Acceso abierto http://purl.org/coar/access_right/c_abf2 |
eu_rights_str_mv |
openAccess |
dc.format.mimetype.none.fl_str_mv |
application/pdf |
dc.publisher.spa.fl_str_mv |
Springer Nature |
dc.publisher.journal.spa.fl_str_mv |
Infectious diseases and therapy |
institution |
Universidad El Bosque |
bitstream.url.fl_str_mv |
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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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Maraolo.Silvia Corcione.Adriano Grossi.Alessio Signori_2021.pdf.txtExtracted texttext/plain55177https://repositorio.unbosque.edu.co/bitstreams/2e790fcb-5ef9-42da-ba99-03de6af459ea/download956da2ca8f0548e19effcd7ac8e6c0c9MD5520.500.12495/5564oai:repositorio.unbosque.edu.co:20.500.12495/55642024-02-06 22:50:48.062http://creativecommons.org/licenses/by-nc/4.0/Atribución-NoComercial 4.0 Internacionalopen.accesshttps://repositorio.unbosque.edu.coRepositorio Institucional Universidad El Bosquebibliotecas@biteca.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 |