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Prompt and Appropriate Antimicrobial Therapy Improves Outcomes of NDM-Producing and KPC-Producing Klebsiella pneumoniae Bloodstream Infections in Patients Hospitalized for COVID-19: A Comparative Retrospective Case-Series.
Bavaro, Davide Fiore; Belati, Alessandra; Diella, Lucia; Poli, Melita Anna; Calamo, Angela; De Candia, Giovanna; Altamura, Maurantonio; Spadavecchia, Felicia Anna; Brindicci, Gaetano; De Gennaro, Nicolò; Di Gennaro, Francesco; Saracino, Annalisa; Carbonara, Sergio.
  • Bavaro DF; Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, 70121 Bari, Italy.
  • Belati A; Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, 70121 Bari, Italy.
  • Diella L; Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, 70121 Bari, Italy.
  • Poli MA; U.O.C. Malattie Infettive, ASL BAT, P.O. V. Emanuele II, 76011 Bisceglie, Italy.
  • Calamo A; U.O.C. Malattie Infettive, ASL BAT, P.O. V. Emanuele II, 76011 Bisceglie, Italy.
  • De Candia G; UOSVD Patologia Clinica, ASL BAT, P.O. V. Emanuele II, 76011 Bisceglie, Italy.
  • Altamura M; U.O.C. Malattie Infettive, ASL BAT, P.O. V. Emanuele II, 76011 Bisceglie, Italy.
  • Spadavecchia FA; UOSVD Patologia Clinica, ASL BAT, P.O. V. Emanuele II, 76011 Bisceglie, Italy.
  • Brindicci G; Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, 70121 Bari, Italy.
  • De Gennaro N; Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, 70121 Bari, Italy.
  • Di Gennaro F; Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, 70121 Bari, Italy.
  • Saracino A; Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, 70121 Bari, Italy.
  • Carbonara S; U.O.C. Malattie Infettive, ASL BAT, P.O. V. Emanuele II, 76011 Bisceglie, Italy.
Antibiotics (Basel) ; 11(11)2022 Oct 31.
Article in English | MEDLINE | ID: covidwho-2089985
ABSTRACT
Secondary bloodstream infections (BSIs) caused by KPC- and NDM-producing Klebsiella pneumoniae (K.p.) during the course of COVID-19 infections lead to significant mortality. Herein, a comparative retrospective case series of KPC- or NDM-K.p. BSIs occurring in COVID-19 subjects treated with Ceftazidime/Avibactam (CAZ/AVI) for KPC-K.p., or CAZ/AVI+ Aztreonam (ATM) for NDM-K.p is reported. All patients hospitalized for COVID-19 in two Italian hospitals with a BSI between March and September 2021 were included. The main outcome was 14-day mortality. Overall, 44 patients were included 23 with KPC-K.p. and 21 with NDM-K.p. BSIs. The median (q1-q3) age was 67 (57-75) years, and 32 (72%) were males. The two groups were similar in terms of baseline comorbidity, or severity of COVID-19. Notably, 14-day mortality of KPC-K.p. BSIs and NDM-K.p. BSIs (26% vs. 38%, p = 0.521) and 28-day mortality (35% vs. 48%, p = 0.541) were similar. A Cox regression model of delayed initiation of an appropriate antibiotic therapy after the onset of symptoms independently predicted mortality initiation between 24 and 72 h (aHR = 12.03; 95% CI = 1.10-130, p = 0.041); and initiation after 72h (aHR = 36.9, 95% CI = 3.22-424, p = 0.004). Moreover, a trend towards an increased risk of mortality was observed for polymicrobial infections (aHR = 3.73, 95% CI = 0.87-15.8, p = 0.074), while a protective effect was observed for a beta-lactam loading dose at the start of treatment (aHR = 0.16, 95% CI = 0.02-1.10, p = 0.064). The high mortality of KPC and NDM-K.p. BSIs in COVID-19 patients may be reduced by an early and appropriate antibiotic therapy. Further efforts should be made to develop antimicrobial stewardship and infection control programs in COVID-19 wards.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Year: 2022 Document Type: Article Affiliation country: Antibiotics11111519

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Year: 2022 Document Type: Article Affiliation country: Antibiotics11111519