Características y evolución clínica de las bacteriemias por Klebsiella pneumoniae productora de carbapenemasa tipo OXA-48 en un hospital de tercer nivel / Clinical features and outcomes of bacteraemia due to OXA-48-like carbapenemase-producing Klebsiella pneumoniae in a tertiary hospital

RESUMEN

INTRODUCCIÓN: El manejo de las bacteriemias por Klebsiella pneumoniae productora de carbapenemasa del tipo OXA-48 (KPOXA-48) es complicado por las escasas opciones terapéuticas y la elevada mortalidad. El objetivo del estudio fue describir las características clínicas de bacteriemia por KPOXA-48 entre octubre de 2013 y diciembre de 2016. MATERIAL Y MÉTODOS: Se recogieron retrospectivamente de las historias clínicas las variables para analizar. La producción de carbapenemasas se confirmó por métodos fenotípicos y moleculares. RESULTADOS: Se incluyeron 38 pacientes con bacteriemia, mayoritariamente de origen nosocomial (n = 31). Un alto porcentaje de las bacteriemias (n = 26) fueron secundarias, principalmente de origen urinario (n = 11). Todos los aislamientos eran multirresistentes con producción de la beta-lactamasa de espectro extendido CTX-M-15 y carbapenemasa del tipo OXA-48. La mortalidad bruta con antibioterapia dirigida adecuada fue del 0% y la inadecuada del 55% (p = 0,0015). CONCLUSIONES: Se pone de manifiesto la importancia de identificar este mecanismo de resistencia, los factores del paciente, el tipo de bacteriemia y la adecuación de la estrategia terapéutica en la evolución clínica

ABSTRACT

INTRODUCTION: Community-acquired Staphylococcus aureus (SA) bacteraemia is a common cause of hospitalisation in children. The occurrence of secondary foci (SF) of SA infection is associated with higher morbidity and mortality. OBJECTIVES: To identify risk factors for SF of infection in children with community-acquired SA bacteraemia. MATERIAL AND METHODS: Prospective cohort. All children aged from 30 days to 16 years admitted to a paediatric referral hospital between January 2010 and December 2016 for community-acquired infections, with SA isolated in blood cultures, were included. Microbiological, demographic and clinical characteristics were compared, with or without SF infection after 72 hours of hospitalisation. RESULTS: A total of 283 patients were included, 65% male (n = 184), with a median age of 60 months (IQR 30-132). Seventeen per cent (n = 48) had at least one underlying disease and 97% (n = 275) had some clinical focus of infection, the most common being osteoarticular 55% (n = 156) and soft tissue abscesses 27% (n = 79). A total of 65% (n = 185) were resistant to methicillin. A SF of infection was found in 16% of patients (n = 44). The SF identified were pneumonia 73% (n=32), osteoarticular 11% (n = 5), soft tissue 11% (n = 5) and central nervous system 5% (n=2). In the multivariate analysis, the persistence of positive blood cultures after the fifth day (OR 2.40, 95%CI 1.07-5.37, P < 0.001) and sepsis (OR 17.23, 95%CI 5.21-56.9, P < 0.001) were predictors of SF. There was no association with methicillin sensitivity. CONCLUSIONS: In this cohort, methicillin-resistant SA infections predominated. The occurrence of SF of infection was associated with the persistence of bacteraemia after the fifth day and sepsis on admission