caa a22 4500 606157883 CHVBK 20210128100616.0 cr unu---uuuuu 210128e20150201xx s 000 0 eng 10.1007/s10096-014-2233-5 doi (NATIONALLICENCE)springer-10.1007/s10096-014-2233-5 Infection with Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae in cancer patients [Elektronische Daten] [M. Freire, L. Pierrotti, H. Filho, K. Ibrahim, A. Magri, P. Bonazzi, L. Hajar, M. Diz, J. Pereira, P. Hoff, E. Abdala] Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-Kp) is an emergent pathogen in healthcare-associated infections (HAIs). The aim of this study was to describe HAIs due to KPC-Kp, as well as identify mortality risk factors in cancer patients. In patients diagnosed with HAIs due to KPC-Kp between January 2009 and July 2013, we evaluated only the first infection episode of each patient, analyzing mortality separately for patients treated for ≥48h with at least one antimicrobial agent proven to display in vitro activity against KPC-Kp. We evaluated variables related to the malignancy, the severity and characteristics of the HAI, and the antimicrobial therapy. We identified 83 HAIs due to KPC-Kp. The 30-day mortality was 57.8% for all infections and 72.7% for bacteremic infections. Of the 83 patients, 60 patients received ≥48h of appropriate treatment and 44 (53%) developed bacteremia. Ten patients (12%) were neutropenic at HAI diagnosis and 33 (39.8%) had infection at the tumor site. The most common HAI was urinary tract infection, seen in 26 patients (31.3%), followed by primary bloodstream infection, seen in 24 patients (28.9%). Forty-four patients (73.3%) received combination antimicrobial therapy, most often including polymyxin (68.3%). Risk factors for 30-day mortality are high sequential organ failure assessment (SOFA) score, need for intensive care stay at diagnosis of infection, and acute kidney injury; the removal of invasive devices related to infection and treatment with effective antibiotics for KPC-Kp are protective factors. In cancer patients, high mortality is associated with HAI due to KPC-Kp and mortality risk factors are more often related to acute infection than to the underlying disease. Springer-Verlag Berlin Heidelberg, 2014 Freire M. Hospital Control Infection and Infectious Diseases Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, 01246-000, São Paulo, Brazil aut Pierrotti L. Hospital Control Infection and Infectious Diseases Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, 01246-000, São Paulo, Brazil aut Filho H. Division of Molecular Biology, Central Laboratory, Laboratório de Investigação Médica 03 (LIM-03, Laboratory for Medical Research 03), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, 01246-903, São Paulo, Brazil aut Ibrahim K. Hospital Control Infection and Infectious Diseases Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, 01246-000, São Paulo, Brazil aut Magri A. Hospital Control Infection and Infectious Diseases Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, 01246-000, São Paulo, Brazil aut Bonazzi P. Hospital Control Infection and Infectious Diseases Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, 01246-000, São Paulo, Brazil aut Hajar L. Intensive Care Service, Instituto do Câncer do Estado de São Paulo, Hospital Control Infection and Infectious Diseases Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, 01246-000, São Paulo, Brazil aut Diz M. Service of Clinical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, 01246-000, São Paulo, Brazil aut Pereira J. Service of Hematology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, 01246-000, São Paulo, Brazil aut Hoff P. Division of Molecular Biology, Central Laboratory, Laboratório de Investigação Médica 03 (LIM-03, Laboratory for Medical Research 03), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, 01246-903, São Paulo, Brazil aut Abdala E. Hospital Control Infection and Infectious Diseases Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, 01246-000, São Paulo, Brazil aut European Journal of Clinical Microbiology & Infectious Diseases Springer Berlin Heidelberg 34/2(2015-02-01), 277-286 0934-9723 34:2<277 2015 34 10096 https://doi.org/10.1007/s10096-014-2233-5 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s10096-014-2233-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Freire M. Hospital Control Infection and Infectious Diseases Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, 01246-000, São Paulo, Brazil aut NATIONALLICENCE 700 1- Pierrotti L. Hospital Control Infection and Infectious Diseases Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, 01246-000, São Paulo, Brazil aut NATIONALLICENCE 700 1- Filho H. Division of Molecular Biology, Central Laboratory, Laboratório de Investigação Médica 03 (LIM-03, Laboratory for Medical Research 03), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, 01246-903, São Paulo, Brazil aut NATIONALLICENCE 700 1- Ibrahim K. Hospital Control Infection and Infectious Diseases Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, 01246-000, São Paulo, Brazil aut NATIONALLICENCE 700 1- Magri A. Hospital Control Infection and Infectious Diseases Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, 01246-000, São Paulo, Brazil aut NATIONALLICENCE 700 1- Bonazzi P. Hospital Control Infection and Infectious Diseases Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, 01246-000, São Paulo, Brazil aut NATIONALLICENCE 700 1- Hajar L. Intensive Care Service, Instituto do Câncer do Estado de São Paulo, Hospital Control Infection and Infectious Diseases Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, 01246-000, São Paulo, Brazil aut NATIONALLICENCE 700 1- Diz M. Service of Clinical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, 01246-000, São Paulo, Brazil aut NATIONALLICENCE 700 1- Pereira J. Service of Hematology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, 01246-000, São Paulo, Brazil aut NATIONALLICENCE 700 1- Hoff P. Division of Molecular Biology, Central Laboratory, Laboratório de Investigação Médica 03 (LIM-03, Laboratory for Medical Research 03), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, 01246-903, São Paulo, Brazil aut NATIONALLICENCE 700 1- Abdala E. Hospital Control Infection and Infectious Diseases Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, 01246-000, São Paulo, Brazil aut NATIONALLICENCE 773 0- European Journal of Clinical Microbiology & Infectious Diseases Springer Berlin Heidelberg 34/2(2015-02-01), 277-286 0934-9723 34:2<277 2015 34 10096