Prognosis of urinary tract infection caused by KPC-producing Klebsiella pneumoniae: The impact of inappropriate empirical treatment. Issue 3 (September 2019)

• Record Type: Journal Article
• Authors: Rodriguez-Gómez, Jorge; Pérez-Nadales, Elena; Gutiérrez-Gutiérrez, Belen; Machuca, Isabel; Martinez-Martinez, Luis; Rivera, Francisco; Cano, Angela; Castón, Juan Jose; Robles, Juan Carlos; de la Fuente, Carmen; Rodríguez-López, Fernando; Rodriguez-Baño, Jesus; Torre-Cisneros, Julian
• Is Part Of: Journal of infection. Volume 79:Issue 3(2019)
• Page Start: 245
• Page End: 252
• Publication Date: 2019-09
• Subjects: Klebsiella pneumoniae -- Carbapenemase -- Urinary tract infection -- Prognosis -- Treatment; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2019.06.014
• Languages: English
• ISSNs: 0163-4453

Abstract

Highlights: Patients with urinary tract infection due to carbapenemase-producing Klebsiella pneumoniae, experienced higher clinical failure than patients with carbapenem-susceptible strains. It is associated with the high rate of inappropriate empirical treatment. Carbapenemase-producing Klebsiella pneumoniae aetiology in urinary tract infection is not independently associated with all-cause mortality. The profiles of hospitalized patients with urinary tract infection of both cohorts are very similar. Previous antibiotics use and colonisation may help to identify carbapenemase-producing aetiology. Summary: Introduction: There is scarce information on the prognosis of urinary tract infections (UTI) caused by KPC carbapenemase-producing Klebsiella pneumoniae (KPC-Kp). Objetive: To investigate the association between KPC-Kp aetiology and clinical failure and all cause mortality and to explore the impact of inappropriate empirical treatment. Material and methods: This is a retrospective observational study of hospitalized patients with UTI due to K. pneumoniae. We explored clinical failure at day 21 and 30-day all-cause mortality using different models of adjusted analysis. Results: We analyzed 142 episodes of UTI; 46 episodes (32.4%) were due to KPC-Kp and 96 episodes (67.6%) were due to non-KPC-Kp strains (62 wild type and 34 EBSL producer). Clinical failure was more frequent in the KPC-Kp group (41.3% vs. 15.6%, p = 0.001). KPC-Kp aetiology and inappropriate empirical therapy were associated in the non-adjusted analysis with clinical failure. When analysed in separate adjusted models, both were found to be associated; inappropriate empirical treatment (OR 2.51; 95% CI, 1.03–6.12; p = 0.04) and KPC-Kp (OR 2.73; 95% CI, 1.03–7.22; p = 0.04) were associated with increased risk of failure. All-cause 30-day mortality was higher in patients with KPC-Kp UTI (39.1% vs. 15.6%, p = 0.002). Bacteraemia was more frequent in patients with KPC-Kp etiology (23.9% vs. 10.4%; p = 0.034). In both cases, the association was not confirmed in the adjusted analysis. Conclusion: KPC-Kp UTI is associated with higher clinical failure and may be due to an increase in inappropriate empirical treatment.