RISK FACTORS FOR INFECTION AND HIGH MORTALITY RATE AMONG PATIENTS WITH KPC PRODUCING KLEBSIELLA PNEUMONIAE BACTERAEMIAS IN A HAEMATOLOGY UNIT
(Abstract release date: 05/19/16)
EHA Library. Galanopoulos A. 06/09/16; 134793; PB1893
Dr. ATHANASIOS Galanopoulos
Contributions
Contributions
Abstract
Abstract: PB1893
Type: Publication Only
Background
Emergence of carbapenem resistant enterobacteriae, especially Klebsiella spp, causing nosocomial infections is growing worldwide and has become a great challenge especially for clinicians and the Public Health System. Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KPC-Kp) infections in Haematology Unit patients are associated with increased mortality.
Aims
This study was carried out to determine risk factors for KPC-Kp infections and predictors of mortality in Haematology Unit patients with KPC-Kp bacteraemias.
Methods
In this retrospective study of a 3-year period, all patients with hospital-acquired KPC-Kp isolation were included and were compared with other non bacteraemic patients. K. pneumoniae were identified by Vitek 2 technology, antibiotic susceptibility was determined by agar disk diffusion method and minimum inhibitory concentrations were determined by Etest. The presence of the blaKPC gene was confirmed by PCR. Molecular typing was performed by pulsed field gel electrophoresis ( PFGE) of Xbal-restricted genomic DNA.
Results
Eighteen episodes of infections were identified and KPC-Kp strains were isolated from 16 patients. Acute myeloid leukaemia was the underlying disease in 10 patients, non-Hodgkin lymphoma in two and acute lymphoblastic leukaemia, chronic lymphoblastic leukaemia, aplastic anaemia and multiple myeloma, one each. Seven of them were males and nine were females and their median age was 70 years (range: 25-83). The medical records of patients were retrospectively collected for demographic, clinical, and microbiological data. Clinical infections versus hospitalization and the outcome of infected patients were defined. The median duration between admission and the isolation of KPC-Kp strains was 24 days. Twelve patients were neutropenic during the bacteraemias. Colonization or bacteraemia from multiple pathogens, including multidrug resistant P. aeruginosa, K. pneumoniae (ESBL), vancomycin resistant Enterococcus and various fungi were concurrently identified in 12 patients with bacteraemia from K. pneumoniae. All patients had either multiple or prolonged hospitalizations and all of them had received antibiotics for prophylaxis or treatment prior to the isolation of the pathogen. Infection due to KPC- Kp was the leading cause to death in 11/16 patients (68,8 %). One patient died of brain hemorrhage (not attributed to his infection), three died of infections caused by other bacteria, after having survived the KPC infection, and three remained alive. Risk factors for KPC-Kp bacteraemia were the number of intravenous catheters or ports, prior prolonged administration of high spectrum of cephalosporins and prolonged hospitalization. In multivariate analysis the age, performance status, prolonged severe neutropenia, resistance to gentamicin and septic shock were independent predictors of mortality.
Conclusion
We found many risk factors involved in KPC-Kp infections among Haematology Unit patients. The high mortality rate in these patients reinforces the urgent implementation of appropriate infection control measures to prevent the spread of carbapenemases producing Enterobacteriaceae.
Session topic: E-poster
Keyword(s): Hematological malignancy, Infection
Type: Publication Only
Background
Emergence of carbapenem resistant enterobacteriae, especially Klebsiella spp, causing nosocomial infections is growing worldwide and has become a great challenge especially for clinicians and the Public Health System. Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KPC-Kp) infections in Haematology Unit patients are associated with increased mortality.
Aims
This study was carried out to determine risk factors for KPC-Kp infections and predictors of mortality in Haematology Unit patients with KPC-Kp bacteraemias.
Methods
In this retrospective study of a 3-year period, all patients with hospital-acquired KPC-Kp isolation were included and were compared with other non bacteraemic patients. K. pneumoniae were identified by Vitek 2 technology, antibiotic susceptibility was determined by agar disk diffusion method and minimum inhibitory concentrations were determined by Etest. The presence of the blaKPC gene was confirmed by PCR. Molecular typing was performed by pulsed field gel electrophoresis ( PFGE) of Xbal-restricted genomic DNA.
Results
Eighteen episodes of infections were identified and KPC-Kp strains were isolated from 16 patients. Acute myeloid leukaemia was the underlying disease in 10 patients, non-Hodgkin lymphoma in two and acute lymphoblastic leukaemia, chronic lymphoblastic leukaemia, aplastic anaemia and multiple myeloma, one each. Seven of them were males and nine were females and their median age was 70 years (range: 25-83). The medical records of patients were retrospectively collected for demographic, clinical, and microbiological data. Clinical infections versus hospitalization and the outcome of infected patients were defined. The median duration between admission and the isolation of KPC-Kp strains was 24 days. Twelve patients were neutropenic during the bacteraemias. Colonization or bacteraemia from multiple pathogens, including multidrug resistant P. aeruginosa, K. pneumoniae (ESBL), vancomycin resistant Enterococcus and various fungi were concurrently identified in 12 patients with bacteraemia from K. pneumoniae. All patients had either multiple or prolonged hospitalizations and all of them had received antibiotics for prophylaxis or treatment prior to the isolation of the pathogen. Infection due to KPC- Kp was the leading cause to death in 11/16 patients (68,8 %). One patient died of brain hemorrhage (not attributed to his infection), three died of infections caused by other bacteria, after having survived the KPC infection, and three remained alive. Risk factors for KPC-Kp bacteraemia were the number of intravenous catheters or ports, prior prolonged administration of high spectrum of cephalosporins and prolonged hospitalization. In multivariate analysis the age, performance status, prolonged severe neutropenia, resistance to gentamicin and septic shock were independent predictors of mortality.
Conclusion
We found many risk factors involved in KPC-Kp infections among Haematology Unit patients. The high mortality rate in these patients reinforces the urgent implementation of appropriate infection control measures to prevent the spread of carbapenemases producing Enterobacteriaceae.
Session topic: E-poster
Keyword(s): Hematological malignancy, Infection
Abstract: PB1893
Type: Publication Only
Background
Emergence of carbapenem resistant enterobacteriae, especially Klebsiella spp, causing nosocomial infections is growing worldwide and has become a great challenge especially for clinicians and the Public Health System. Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KPC-Kp) infections in Haematology Unit patients are associated with increased mortality.
Aims
This study was carried out to determine risk factors for KPC-Kp infections and predictors of mortality in Haematology Unit patients with KPC-Kp bacteraemias.
Methods
In this retrospective study of a 3-year period, all patients with hospital-acquired KPC-Kp isolation were included and were compared with other non bacteraemic patients. K. pneumoniae were identified by Vitek 2 technology, antibiotic susceptibility was determined by agar disk diffusion method and minimum inhibitory concentrations were determined by Etest. The presence of the blaKPC gene was confirmed by PCR. Molecular typing was performed by pulsed field gel electrophoresis ( PFGE) of Xbal-restricted genomic DNA.
Results
Eighteen episodes of infections were identified and KPC-Kp strains were isolated from 16 patients. Acute myeloid leukaemia was the underlying disease in 10 patients, non-Hodgkin lymphoma in two and acute lymphoblastic leukaemia, chronic lymphoblastic leukaemia, aplastic anaemia and multiple myeloma, one each. Seven of them were males and nine were females and their median age was 70 years (range: 25-83). The medical records of patients were retrospectively collected for demographic, clinical, and microbiological data. Clinical infections versus hospitalization and the outcome of infected patients were defined. The median duration between admission and the isolation of KPC-Kp strains was 24 days. Twelve patients were neutropenic during the bacteraemias. Colonization or bacteraemia from multiple pathogens, including multidrug resistant P. aeruginosa, K. pneumoniae (ESBL), vancomycin resistant Enterococcus and various fungi were concurrently identified in 12 patients with bacteraemia from K. pneumoniae. All patients had either multiple or prolonged hospitalizations and all of them had received antibiotics for prophylaxis or treatment prior to the isolation of the pathogen. Infection due to KPC- Kp was the leading cause to death in 11/16 patients (68,8 %). One patient died of brain hemorrhage (not attributed to his infection), three died of infections caused by other bacteria, after having survived the KPC infection, and three remained alive. Risk factors for KPC-Kp bacteraemia were the number of intravenous catheters or ports, prior prolonged administration of high spectrum of cephalosporins and prolonged hospitalization. In multivariate analysis the age, performance status, prolonged severe neutropenia, resistance to gentamicin and septic shock were independent predictors of mortality.
Conclusion
We found many risk factors involved in KPC-Kp infections among Haematology Unit patients. The high mortality rate in these patients reinforces the urgent implementation of appropriate infection control measures to prevent the spread of carbapenemases producing Enterobacteriaceae.
Session topic: E-poster
Keyword(s): Hematological malignancy, Infection
Type: Publication Only
Background
Emergence of carbapenem resistant enterobacteriae, especially Klebsiella spp, causing nosocomial infections is growing worldwide and has become a great challenge especially for clinicians and the Public Health System. Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KPC-Kp) infections in Haematology Unit patients are associated with increased mortality.
Aims
This study was carried out to determine risk factors for KPC-Kp infections and predictors of mortality in Haematology Unit patients with KPC-Kp bacteraemias.
Methods
In this retrospective study of a 3-year period, all patients with hospital-acquired KPC-Kp isolation were included and were compared with other non bacteraemic patients. K. pneumoniae were identified by Vitek 2 technology, antibiotic susceptibility was determined by agar disk diffusion method and minimum inhibitory concentrations were determined by Etest. The presence of the blaKPC gene was confirmed by PCR. Molecular typing was performed by pulsed field gel electrophoresis ( PFGE) of Xbal-restricted genomic DNA.
Results
Eighteen episodes of infections were identified and KPC-Kp strains were isolated from 16 patients. Acute myeloid leukaemia was the underlying disease in 10 patients, non-Hodgkin lymphoma in two and acute lymphoblastic leukaemia, chronic lymphoblastic leukaemia, aplastic anaemia and multiple myeloma, one each. Seven of them were males and nine were females and their median age was 70 years (range: 25-83). The medical records of patients were retrospectively collected for demographic, clinical, and microbiological data. Clinical infections versus hospitalization and the outcome of infected patients were defined. The median duration between admission and the isolation of KPC-Kp strains was 24 days. Twelve patients were neutropenic during the bacteraemias. Colonization or bacteraemia from multiple pathogens, including multidrug resistant P. aeruginosa, K. pneumoniae (ESBL), vancomycin resistant Enterococcus and various fungi were concurrently identified in 12 patients with bacteraemia from K. pneumoniae. All patients had either multiple or prolonged hospitalizations and all of them had received antibiotics for prophylaxis or treatment prior to the isolation of the pathogen. Infection due to KPC- Kp was the leading cause to death in 11/16 patients (68,8 %). One patient died of brain hemorrhage (not attributed to his infection), three died of infections caused by other bacteria, after having survived the KPC infection, and three remained alive. Risk factors for KPC-Kp bacteraemia were the number of intravenous catheters or ports, prior prolonged administration of high spectrum of cephalosporins and prolonged hospitalization. In multivariate analysis the age, performance status, prolonged severe neutropenia, resistance to gentamicin and septic shock were independent predictors of mortality.
Conclusion
We found many risk factors involved in KPC-Kp infections among Haematology Unit patients. The high mortality rate in these patients reinforces the urgent implementation of appropriate infection control measures to prevent the spread of carbapenemases producing Enterobacteriaceae.
Session topic: E-poster
Keyword(s): Hematological malignancy, Infection
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